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O iPR I O
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r
AND UTILITY CONNECTION PERMIT .fit z.4, /Z
1�'NESD�
I. Pint Fat P ERMIT NO. 9 � 7(
2. Pink city / `�
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/5 79/ -kV /lie ` rite
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name)
OWNER - d 11+(\- t' C r` iN 0 1N (Phone) ! 2- Zs (- / ‘_5g
(Address) _5 ATCre.
BUILDER Name) - (Phone) 7---52 7
Name � �''� � ti'�/� i� � t D d � hone
(Contact Name) - Yres (Phone) .</r
(Address) 6 x'61 � c l <'v' rK-� 1i vc 9»_ Let, .. _
TYPE OF WORK ° New Construction °Deck °Porch DRe- Roofing DRe- Siding � Q own Level Finish ❑ Fireplace
°Addition °Alteration °Utility Connection \ Z 2.A'7S
CODE: DI.R.C. DI.B.C. ° Mist: Lam. "XO9nJ4 • il77,
Type of Construction: I II III IV V AB
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 3 (excluding land)
I hereby certify that I have furnished information on this application which is to the bat of my knowledge true and correct. I also certify that I am the mina or authorized agent for the
above- aaentioaed arul mat a8 consuvctioa will costfwna to all existing aloe and to al !awl and will proceed in aocadance wilt submitted plans. I am aware that the building
ofic can revoke ' permit for just cause. Further hereby agre that the city offi or a des ma enter upon the property m perform needed inspect
x .t.. — 7d. - (LJ 20:3 `I-57 7 5 -z y -ZO/7
Signature Contractor's License No. Date
Permit aluation 2 c o ) _ C v Park Support Fee # $
Permit Fee $ (.,-, Z - S SAC # $
Plan Check Fee $ - Water Meter Size 5 /8"; 1 "; $
State Surcharge $ /... -) Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 . , C Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ / / 7, 75
This Application Becomes Your Build / ing Permit When Approved Paid f 1_ 7 J ., eipt No. 4, S .'73
Date Si Z i )_.--
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date 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 INSPECTION
INSPECTION RECORD
SITE ADDRESS /57q/ SIZ4A ye
NATURE OF WORK t. L. 141
USE OF BUILDING C%cr
PERMIT NO. 1Z DATE ISSUED 5., 7-4
CONTRACTOR PG ft/., /9 PHONE Z-47. 5"9�
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
01110111.111r 1 1
1F _
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING [., W1(IIIEVE -
INSULATION MIEMINNIMI
ELECTRICAL 11111111111011M
PLUMBING 6m t1 mirsa J usfo
HEATING (if required) �y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1
FINALS
BUILDING VL 4 _ g (7/
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.
GAP Al 1 IMCDD/_TIMIC /ORO\ AA7_ORn(1