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� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
U / � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
l J AND UTILITY CONNECTION PERMIT
N W ES O
1. White File PERMIT NO .
2. Peak City ( I t `✓ �` `
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 v Di.
LEGAL DESCRIPTION (office use only) _ _1
LOT 3 BLOCK J ADDITION � ` / , ^�l . PM
'�"" ,� J 1 S 31 ^07 1 t
(Name) OWNER �" ^^"' L J o "`^ -CA-� 1 L ' •7 (03 -
(Phone)
Address (O SS Alet D /vtai Le_ C vo 1✓k cc 3e /
( Name) M IA ' J l hone
[ 1 P „ - ` 111'(/ • (Phone) 7& - S 3 b'1 9'
p -� q
(Contact Name)) c 1-t !� : nb� i/� (Phone) G `2--61 `2--61 (l p
-
(Address) e t (5 6 S ' 3 ' 'r`{.
A.�f JO , " �.a'}p it e ✓al/G m , Ss 3 (0 J
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding Tower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE• L R.C. DLB.C. ❑ Ivlisc:
Type o Construction: I 11 III 1V ® (P /� 615-47 Occupancy Group: A B E A I M S U PROJECT COST /VALUE $
Division: 2 3 4 5 (excluding land)
I beret t I .. 4 o non n this lic is to of knowledge rund r I also I am nr authorized for the
above . ed . � � i. ' ,n , ction o will con ation to all w existin ich state the best and local my laws and w pro a ceed corect. i accordance certify with that submitted the plans
. I am or aware auth that the agent budding
offi ii. jfr ermore, I hereby agree that the city official 5-4 �� g� urn the property to perform needed' cti 1
X
• • V V ignature Contractor's License No. to
Permit Valuation Park Support Fee # $
Permit Fee $
1-1.:14- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ ( t Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 3-1-co Water Tower Fee # $
Mechanical Permit Fee $ 7 Builder's Deposit $
Sewer & Water Permit Fee $ Other / $
Gas Fireplace Permit Fee $ TOTAL DUE $ 44 , -7
Thus A . . ; : .. es Your Building Permit W pproo d Paid / 3 0. Is' - Receipt No. (p S G 0 1-
i i Date /i_ / . q BY P n','
1 � , t 3. � �
ding ■ ate
This is to certify a ... -st in the above application and accompanying d ems is ' accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by i / .. er co temporary Certificate of Zoning pliance d allows construction to commence. Be fore occupancy, a Cer tificate o f Occupancy must be
issued.
Plannir: - to Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE BUILDING AND IN SPECTION
INSPECTION RECORD
SITE ADDRESS 3z 13 -
NATURE OF WORK
USE OF BUILDING Kc-s
PERMIT NO. t( S � DATE ISSUED to 25 71
CONTRACTOR t /•) PHONE 412- ch 9 - ¢��'-
NOTE: THIS IS NOT A PERM T FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
IWINIERMOIRIEW) 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 7 // e //
INSULATION
ELECTRICAL
PLUMBING Visu&
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING tz -z
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough -in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447 -9850