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o PR / 0 4, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
en AND UTILITY CONNECTION PERMIT
en 4.4vNESO1 i. White File
2. Pink City PERMIT NO . l y
/,,,�. l -s3 e
3 Yellow Applicant T
(Please type or print and sign at bottom) r.
ADDRESS --��. --. K-2 f M ZONING (office use)
1 7 V ( G N . +--. f,( to S. F . sC3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER-- _ 6 /2 - 7" - / 7 4 a(
(Name) l C b1-$ i7 .t f IC • (Phone) S ra - ' o - 'XI `(Z l-4 it...
(Address) 1 C. F- LJ �i��ci T1 t2L C . t
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. El Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5 i
A.... 1 hereby ce have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above- - ntioned t •.pci •,4 nd t all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offici, can ev • this pet it f.f t eau helrmore hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
I X
if e gnature Contractor's License No. Date
i
Permit Valuation • l °CO i Park Support Fee # $
Permit Fee $ — SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 39 ' IS
Thi • • pplica o B come • our Building Permit When A ..roved Paid / Receipt No. ''' 7C/ k : ■ A AP A / Date 1 47../ 7 / By e ;
'Buil - _- 4+,t t Date
This is to cer that the re. i es in the above application and accompanying docu nts is in ccordance with the City Zoning Ordinance and may proceed as requested. This document
when sign s e. /• the CI) P m. c institutesa temporary Certificate of Zoning co 'lance d allows construction to commence. Before occupancy, a Cotitcate of Occupancy must be
issued if
_ - _ _ - to Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRI0R L I
BUILDING ANINSPECTION
INSPECTION RECORD
SITE ADDRESS 1 . 7 , 42 I .t' t -f ,
NATURE OF WORK N . �� ' � d o.- - =.-v ." .
USE OF BUILDINGS
PERMIT NO. DATE ISSUED 1' Z /ao/11
CONTRACTOR -Qlc_t4aw� iSSc PHONE (Z • 77p- A7 ?7
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I +OOTMNG —• f I
1$OUNDATION {-Dior to Backfill) J
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEEDC
FRAMING
INSULATION
ELECTRICAL
?LUMBIN
HEATING (if required)
BEcsL-A- —
-
-�AS
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
_GRADING-Prior to Sodding) /
BUILDING
ELECTRICAL G
L-UMBENer
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