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o4 PR /p� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.�. AND UTILITY CONNECTION PERMIT
���NES��� ; �n CY PERMIT NO
3 Yellow Applicant 1 4 1
(Please type or print and sign at bottom) 1
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
A - OWNER ;T -T^
(Name) l C 4 t tutu ..J,. d- Ca ro 1 R NI 555c ►'1 (Phone) CoSl - c -5Fg _C''/ SvcC.
(Address) / 5 SS 5 r3 c wt - 41/ E N W Pr i yr L a v e, 07 /11 S S 3 7 9
BUILDER
(Company Name) e) : Y1 'LY (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ['Porch Eke- Roofing ERe-Siding Lower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III 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. I also certify that I am the owner or authorized agent for the
.......\..
above - mentioned property 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 revoke this permit for just cause Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X " 1 3 --- -/
Signature Contractor's License No. Date
Permit Valuation ./�y�'�� ' ' Park Support Fee # $
Permit Fee $ 1 � 7 rZ � SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 2 , - Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5-4_ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ (f-3 * 7 r
This App t o 1 ,, Imes Your Building Permit Whe Ap oved Pa , Receipt No. (a)S ii 5
By /4
Date 2 Z
i _ rl
:uildin_ fticial Dat•
This is to cert that , st in the above application and accompanying doc ment is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe.4 the , Pia er constitutes a temporary Certificate of Zoning c mpli cc and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
� : i 111■.— 5 f Z_. LOw42.ie rr- w 4 ,4 t of paitri f
P I nning Dr 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
( .(1) RiO Date Rec'd
= \ CITY OF PRIOR LAKE PLUMBING PERMIT
Z-
447
itij A'NES( WP
I . Blue File Yel PERMIT NO . 47
2 3 .
3. Yellow City ow Applicant ( Z
(Please type or print and sign at bottom)
i ADDRESS ZONING (office use) " / " - c.3 4 Ave A/ W
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � /
(Name) J°S C C6 1 J tSSe 1'1 (Phone) 6 �i S ?G
(Address) / 5 5 B(r✓ i o n4 AVE /J W Pr l rY l_ e � / Al 5 375'
‘...), APPLICAN Re. b1 in epth s Li-c= — �
(Name) `r�.
�.. my:..�� L - j f I / 5 1 D l n (Phone) _ -4---- - - '� 95 0� -
(Address) / C189/ /JCir(Ow 4ti E aC7rdeLh 53 3SO.
w (Address) (City) (Zip Code)
(Contact Person)- Pa - -e P 0 hi 1 h (Phone) q5 - .b D 7q3
APPLICANT SIGNATURE j DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
/ Bath Tub with or without shower Rough -ins
/ Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
/ Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
/ Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
' Most $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ .50 u/
The minimum surcharge for a TOTAL PERMIT FEE $b '7274' l r
"fixed fee" permit is $5.00
This Appl ' , , ti I Becomes Your Building Permit W n proved Paid Receipt No.
iCi1 _ / Z r Z Date By
ui di ''Official _ D to
. otice 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 R
SITE ADDRESS t
NATURE OF WORK L..� � - r r�v�s
USE OF BUILDING 17-,e A - f�--
PERM NO. / ' / DATE ISSUED 5/ z-- f z
CONTRACTOR /</ /-I , � � PHONE 4 ct - 74c - ` s
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 TIN ---- �
1 FIDAT rior to Backfill) 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
,SEWERVNATER4
FRAMING 7/8/(2
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
..„triarrEttlfteE. -173
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
.46"flarior to Sodding)
BUILDING
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