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PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
E AND UTILITY CONNECTION PERMIT
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4f1IVNES0.1: I White File
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2 Pink City PERMIT NO. t 1 _ Ii
.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
P LYr&S(7--c • '1" NI - 6
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID Z'7; ' Sj ( ."`.1:::)
(Name) 1- L (4A E-- �� 411'' (Phone) 9t 57 4/
z - s- 7 7y2
(Address) ; `C-S --
BUILDER
(Company Name) �r/Y \l�' (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 1:1 New Construction ❑Deck ❑Porch ['Re-Roofing ❑Re- Siding ['Lower Level Finish Fireplace
['Addition ['Alteration ['Utility Connection
CODE: t1.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II HI 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 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
above-mentioned property and that all constructio 1 confor to a sting state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can r . e per , r just • se Furt or I h . eby f fat the city official or a designee may enter upon the property to perform needed inspections.
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Signature Contractor's License No. Date
Permit Valuation 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 $
* Fireplace Permit Fee $ C 4 .50 TOTAL DUE $ S-4:-. 50
This plicat•.n) . ;'.mes Your Building Permit Wh n App • s ved Paid , V Receipt N 1�4Z 1 /
Date tom( t $ f f By W
0 r, r
, Bui . • „ Official Date
This is to cer 1 that the ,' , est in the above application and accompanying document is in ac ordance with the City Zoning Ordinance and may proceed as requested. This document
when signe . the 6 t/ r ne - constitutes a terupoiary Certificate of Zoning compli cc and ,flows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
(d t 5 ' /
4ng Directo Date Special Conditions, if any
hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRI0R BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 434(
�,-5
NATURE OF WORK W o 0 - teL4C f, -rrr C (
USE OF BUILDING
PERMIT NO. A DATE ISSUED 7t1
CONTRACTOR J , (/t J PHONE q z -445 -
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING i R, 1 /04 /i I
1 FOUNDATION (Prior to Backfill) 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
1-tEPrTiftfilifteq u i red)
FIREPLACE L c9ca0
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I _ I
FINALS
_C Sodding)
BUILDING •
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
.