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Date Recd
BUILDING PERMIT,
CITY OF PRIOR LAKE �L • , Z.- - / 1
PRI RY CERTIFICATE OF ZONIN COMPLIANCE
O
6 : a TEM AND UTILITY CONNECTION PERMIT
PERMIT NO r ( 13 , C)
1 White File Cit 3
2 Yell w APPlicant
. ZONING (office use)
NE50 [.
(Please ,e or ,rint and si:n at bottom)
ADDRESS f .SLR
377& free /1%-e / 1
LEGAL DESCRIPTION (office use only) pID
LOT BLOCK ADDITION
(phone)
OWNER f �'
(Name) Pt �► "t
(Address) y �y ' 6/ (Phone) � Psi
BUILDER .
(Company Name) S's�> Z
_ e I '. f .rte : � �71Z2rile /4.41 (Contact N ame) -e e 7 ,� y e �^° -1 11/4 i ;, ❑ Fireplace
(Address) ��� � ❑Lower Level Fin
Re- Roofing ❑Re- Siding
Deck [Porch ❑ av/
WORK ❑ New Construction Dleration ❑Utility Connection �� Y
TYPE OF ❑Addition ❑ ❑ Misc.
LB.C. V A B PROJECT COST /VALUE $
CODE: •R• I II III IV M R S U (excluding land)
T of o struction: A B E F : P 11c : 100 Grou 1 Occupancy P k nowlcg Division: e true and cottect, 1 alsu certify that I a m the owno athoyt which is to the best of my d roceed in accordance with that I m e o n r a
state and local laws and will p enter upon the proPerrY p /
thereby a. , that I have furnished information he this ll conform to al that the city of or a designee may
io uty and that all con I hereby g yr) Date
above-mentioned property Just a Furthermore, /� r�
official ca. � V
Contractor's License No.
Signature Support Permit Valuation , , I 0 Park Fee # 111111111111111111111111
0 Size 5 /8"; 1
Permit Fee W ater Meter
Plan Check Fee Pressure Reducer
Sewer /Water Connection Fee #
Penalty Water Tower Fee
Builder's Deposit
Plumbing Permit Fee .
i
This
Mechanical Permit Fee Other ,�
Sewer & Water Permit Fee TOTAL D i,l �� �L "�3 t'
Fireplace Permit Fee — '� cei•t No.
Gas Firep Paid '
Permit en A l roved —�
c
n Becomes Your Building Date
thOrillibi' Date ioceed as requested. This document
Certificate of Occupancy must be
&lildim_ Official Ordinance and may V
lia e and allows c w the to commence O . Before an dupa y pr a application and accompanying docu ents i in accordance with the City This is to ce that t � request in the above app oiaiy Certificate of Zoning co
when signe• e Ci Planner constitutes a temp Special Conditions, if any
issued. fl —_ Z Z
�� d ate fax (952) 447 -4245
. _ ! � a : - inspections (952) 447 -9850,
a 24 hour notice for a ll insp
4646 Dakota Street Prior Lake, MN 55372
Residential B Additi ons uilding t PS ing l e ermit F ami Checklist
y H o s
BY: i �:
Date:
Building Pe iii : - PR: Zoning:
Site Address - �--- � (
Legal: L B Subdivision:
Existing Structure: YES or NO
CONFORMS TO ZO
NING 444111 NO
ORDINANCE
Yard Setbacks: NOT APPLICABLE Requirement Proposed
MEETS CODE I
• Side Yard 10'
(25' if abutting a street, 30' if abutting a street in
Cardinal Ridge)
• Side Yard 10'
• Rear Yard 25'
• Townhouses Must be consistent with
approved plan for
development
ANY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUST BE REFERRED TO THE
PLANNING DEPARTMENT. ALSO, ANY DECK ON A LOT WITH A SUSPECTED BLUFF, OR ANY
OTHER UNUSUAL CIRCUMSTANCE MUST BE REFERRED TO THE PLANNING DEPARTMENT.
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW. _
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of P1I Date Recd
CITY OF PRIOR LAKE PLUMBING PERMIT
t�NESO
-- ._)*t C f \Q.... OSLA VQ (2- `)(l 4(1 Ibn c PERMIT NO
3. Yellow AppHant 0
CP case type ar point and si$n at bottoms)
.ADDRESS ZONING wax use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIP
OWNER
(Name) (Phone)
(A)
APPLICANT �c`n�XX�� � mb� �.���c_ ( p h ) a5 a W- n -to
(Address)
‘ 55Lk 9.Q_A Oa .s S___ W 1 kQ-- SS31Z_
(Address) (city) (Zip Code)
(Contact Person) Q_-cV jC- `' (Phone) �` �t�� 3U� 3
APPLICANT SIGNATURE ' A'_,Llk DATE (\ ` \ a ra
APPLICANT PLEASE COMPLETE BELOW
Quantity _ Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
i Dishwasher ( Water Heater
— 1 Floor Drain Water Softener
`� Lavatory (Bathroom Sink) ) Stand Pipe (Washing Machine)
1 Laundry Tray (1 or 2 compartment sink Sewage Ejector
I Shower Stall _ Backflow Assembly
1 Sinks Backflow Assembly Test
Bar Sink _ Lawn Sprinkler
�' Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Mut6- faazlly 1% of jab cost with a $49.50 minimum Residential, New One & Two -Family S14930
Residential, Additions & Alterations 549.50
Estimated Cost S Building Permit #
PL R 3' G PERMIT FEE $
ST: SURCHARGE $ SO PAID YY
I ALPERMLTFEE $ 3UILDNG PERMIT
(Office use only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date BY
13uildihht Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S. E., Prior Lake, Minnesota 55372
Nor
f 0 0.
\ v•ra e 4 °".
•
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD /i74H73 3770 ADDRESS 7O 4REAI aria ,
TYPE OF WORK CX
USE OF BUILDING /—
PERMIT NO. DATE ISSUED /Z. II .1 /
BUILDER MEST PHONE # 45/. e29, *16"
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR 041E
Foon 1/EkIF y�/S77�tJ ' 1 1
PL CE NO C6NCRETE UNTIt ABOVE HAS BEEN SIGNED
1 1
FINAL I ? , z. 1 I'1 1
FOR ALL INSPECTIONS (952) 447 - 9850