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PRI�
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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z ��
AND UTILITY CONNECTION PERMIT
1. white File PERMIT NO .
2. Pink City / �/ o f i
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 17/ -, , hhx1 --r:t 1 I liu .R ZONING (office use)
.ov tcsL2 1 /41b 4S 37Z
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION i,(nr-,r `5 h oft PID 25 3`i 0072.
OWNER //
(Name) - DO 1. K-
toy is- / //y (Phone)
(Address) / 7/ 4 1 2 fiwr7s "s `✓c � f / %/(J �/icv Zei L /PAL) 4- 7 - -7372-
,
BUILDER
(Company Name) Ti ., ( v�lL kiin (c. t vlAJe LLL. (Phone)
(Contact Name) A41 .e. — >i',j• t L. (Phone) t /Z - 7 3 0 2 -3
(Address) - " - /ti / yi 0 jj. iG9 m 5 J 1 ) Lt
/ vv h C'�: /e /(1/x.1 ��j C/ /6
TYPE OF WORK ❑ New Co. . ion ['Deck ['Porch ['Re-Roofing ['Re-Siding ['Lower Level Finish ❑ Fireplace
❑Addition teration ['Utility Connection
CODE: ❑I.R.C. ❑LB.C. ❑ Misc:
Type of Construction: I II HE IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished ' • . ation 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 :., . ..nstruction will confirm to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke ... or cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X .� ----- / q / z V / -3
ignature Contractor's License No. Date
Permit Valuation ti t Park Support Fee # $
Permit Fee $ -7 :2) - 7 SAC # $
Plan Check Fee $ 4 1 f Water Meter Size 5/8 "; 1 "; $
State Surcharge $ — Pressure Reducer $
Penalty $ l Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 Ef Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE - $
This Ap d1 , i . ` � : • comes Your Building Permit , A vved Paid � / 7 (� i pt No. C (y 0 /
'i
1
4- z l ( = I , Date l}- ZI . /3
• • .', • S i cial ' Date
This is to certify that th request in the above application and accompanying .. meats is . accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed . e C Planner constitutes a temporary Certificate of Zoning .. mplian • and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
c� 4 z ; (
Planning ..:.., .) a 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
04 S PRio Date Rec'd
N e CITY OF PRIOR LAKE PLUMBING PERMIT , c,_ r 3
v B1
44NTES0
1. Blue File PERMIT NO. 7
2. Gold City /� w
3. Yellow Applicant
* print and sign at bottom)
ADDRESS ZONING (office use)
1 5L n 5- + fcci,) S vA/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER --�
(Name) ) a ., - k A 1.it 2 et. cj ✓i k2 (IV (Phone)
(Address)
�ameL` \ `xe - 5 / 0 Q.-Vet 4" 0 («( on ) lQ 12 - 7 Sit ZZS S
ressi) LP 53) 3 *"- - .. L.t C'f ii>f P-1 S r.1V S 7
(Address) (City) (Zip Code)
ontact Person ^ �\ {_ ti Lei LLc, -- CX495 - 7 c t (Phone) 5v9
• PLICANT SIGNATU' DATE - 2.5144.3
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 I% of job cost with a $49.50 minimum Residential, New • - : Two - Family $149.50
Residential, :. • itions & Alterations $49.50
Estimated Cost $ Building Permit # ^ D
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50 �-�� it_
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
IMMOMMOMMIONNIPINS T"t"r`Ail
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS / 7/3 Z sv /'sC 7 77e_,./ �-
NATURE OF WORK � eJp-i /-- -j
USE OF BUILDING
PERMIT NO. / ? . Z DATE ISSUED ' -
CONTRACTOR ej)/ .5 e-77CC -.1 ( c),L.0, PHONE (i Z . 7s :. 3C3
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING c- ,�5 , 3
INSULATION
ELECTRICAL
PLUMBING ►5 f !? s -i3 - O
HEATING C -,3 - I/
COV ORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH
FINALS
•
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