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of PR / CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ¢ // //
AND UTILITY CONNECTION PERMIT
A '...... NE solt . I. White File f
2. Pink City
PERMIT NO / / Z33
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
JCS J,4 r s /<-_Y A ,1'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER pp ■
(Name) p1 a� 0l e !'ui/ �k- (Phone) 95z-- 8 q V- 4aY9
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch DRe-Roofing DRe-Siding Lower Level Finish ❑ Fireplace
DAddition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C.
❑ Misc. 1 ��
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned pro w and that 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
official can rev. - this per t for just se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X j � (, �CJ'�'�- V /////t
Signature Contractor's License No. Date
Permit Valu. .:' n 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 $ 3
This Applic i Becomes Your Building Permit When Approved Paid 21 , 2 J' iipt No. 6 2-57
Date t.„ t
ding Official Date
This is to cert 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 Prior Lake, MN 55372
Residential Building Permit Checklist
• ish or Interior Alteration 'to Single Family Homes
BY: / / Date: #• //, 1/
Building Permit / / , 13 3 PID: Zoning:
Site Address 36 07 P
Legal: L B Subdivision:
Existing Structur YES o NO
CONFORMS TO ZONING YES NO
ORDINANCE
YES ' NO
Is this an expansion of the existing footprint or Refer to Planning
building height?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? ✓
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single _
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
•
L : \TEMPLATE\ALTCHCK.DOC
PRIOR LAKE BUEATMENT
PLDR G AND O INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3Co 0 OEF`El2S i a ,v✓
TYPE OF WORK GG W�YC. L.�_1/� - L / ,f
USE OF BUILDING � 1/4-- J
PERMIT NO. / DATE ISSUED ¢ ((. GJ
BUILDER C& /CK__ PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 FRAMIN / NJvc-ien or■1
JFINAL
FOR ALL INSPECTIONS (952) 447 -9850