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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / 2 -
AND UTILITY CONNECTION PERMIT
*NES
I. White File
2. Pink City PERMIT NO . / " / �
7 2
3. Yellow Applicant cam"
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ ` e o 7-4- N(�vm ID C a d--/"' Mpg-, 141-_- xi c ? " 1 - 7
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
6/2 79Y13.3) Q ) h
OWNER Q t.cl . ad if . 4 PJ /�'l w�/ '1/ 7 �1 (Phone) �/ Z ^ e7 �3 �'C
(Address) I /el) I i/� ri,962- /V N(9,- t eira -- li1/1 $ 3 7 z
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe- Roofing ORe- Siding ow:Level Finish 0 Fireplace
DAddition OAlteration OUtility Connection
CODE: DI.R.C. DLB.C. D Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F III MR S U PROJECT CO /VALUE $
Division: 1 2 3 4 5 (excludi land) '-.,
I hereby certify that . - - information on this application which is to the best of my knowledge true and correct. I also certify that I am the ow ' er or authorized agent for the
above - mention • • • • ' and that all co.:. • ion will conform to all existing state and local laws and will proceed in accordance with submitted plans. . am aware that the building
official can r' • is permit for just . s • ' urthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed insp ctions. j
' gnature Contractor License No. 1' D• e
Permit Valuation 4- 600 C C) Park Support Fee # $
Permit Fee $ 07-- z SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1 "; $
State Surcharge $ Z _ 00 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 6l$1,6672 x >o , /,‘ " (hp $ /'..3, 9:5—
This Application Becomes Your Building Permit When Approved Paid /43 . 75 Rec Ant No.
Date / 7 /.3 B .,
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
DEPARTMENT OF
PRIOR LAKE BUILDING AND IN SPECTION
INSPECTION RECORD
SITE ADDRESS /G h' /NhCi4
NATURE OF WORK `.,O Eli L6V i L.
USE OF BUILDING
PERMIT NO. DATE ISSUED . •
CONTRACTOR AtAl A/ .r/�. PHONE ws. 117577372
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING )/3 Oj/7
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1
FINALS
BUILDING 1 3 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.
FOR ALL INSPECTIONS (952) 447 -9850