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o* PR1 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
o
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE (o- , /3 t .
AND UTILITY CONNECTION PERMIT
4.'HNESOi* t White File /3, 5757 2. Pink City PERMIT NO
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 171 fiCfle Dr.. /./
LEGAL DESCRIPTION (office use only)
LOT / BLOCK ADDITION /74' �i. PID Z5, 44a _ v 21.0_0
OWNER C j &c � ," K e lI `/ ).-0/se 'I (Phone)
(Address) 3 171 /Yk k.0 I, VC
BUILDER /
(Company Name) Dee? 4 JG i lc & /h. rJ (Phone)
(Contact Name) ..) " 1 2- (Phone) 6 /2 -30 6 - `1 1 R ti
(Address) f 7 7 Z ce Li, Csi- ZK e,.; .`/ fie, / A)
TYPE OF WORK ❑ New Construction DDeck orch DRe- Roofing DRe- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: K.R.C. DI.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and coned. I also certify that 1 am the owner or authorized agent for the
above - mentor. • : ... - .ty and that all ct .struction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c. revoke thi .e i . Ore. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
( X 20 'f 6CcIS a 5 1, L///(4
- Signature Contractor's License No. Date
Permit Valuation , 30 Q,�:a -- Park Support Fee # $
Permit Fee $ }0 �it � / Y — SAC # $
Plan Check Fee $ /DS - - v 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 DUEe 6 . 7. /3 $ Z7 s 30
n
This Aiycatio co • • Your Building Permit • • en , pproved d p` 3 Receipt No. / / }C /
,
/ r
Date iir B
Building Oliicia Date
----....,
This is to c - th t th r•qu's in the .ove application and accomp docu ents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
vhcn sig. • y t ' Ci , ' la n cons /utcs.a temporary Certificate o f Zo ng c pl iance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
sued. / 1 /
,,T `7 t
Planning Dir- 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
P R I R DEP ARTMENT O
LA BUILDING AND INSPECTION
K E F
NSPECTI
. o
INSPECTION RECORD
SITE ADDRESS 3/T7 Iltwt i O,,'t/
NATURE OF WORK
USE OF BUILDING
PERMIT NO. • - DATE ISSUED • •
CONTRACTOR Depatwiste Rives PHONE &a...36? 44
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING ' Vi !3
1 I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING -- 7-0- .__
INSULATION
ELECTRICAL
, 411111•111•11111.0,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 - I
FINALS
BUILDING
ELECTRICAL 1
ISINNONIO
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