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PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /0./f, /Z.-
en
OF AND UTILITY CONNECTION PERMIT
4%N1VEsol' t. white File
2 Pink city PERMIT NO. /Z f 2.a3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/621 &L/2 c'i glE ra fX':e) < m r7)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) Q vQ Ski, C.- 1 / - (Phone) 7 6 7 6' / 7
'-
(Address)
1 BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ['Porch ORe- Roofing [Me- Siding er Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection ((((
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III 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 information on this application which is to the best of my knowledge true and correct. I also certify that 1 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, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ` .Qm lo /9 -&
Signature Contractor's License No. Date
Permit Valuation 3 U O tU ^ 0 f) Park Support Fee # $
Permit Fee $ / - 7 SAC # $
Plan Check Fee $ 7 Water Meter Size 5/8 "; I "; $
State Surcharge $ /-sz / - s Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 Sr) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Pe it Fee I $ 54 5� TOTAL DUE $ /g.5 Z5
-
^
This Application :,:omen Your Building Permit When Approved Paid /g 5 Z Receipt No. (' '
Date /d . / `/, / 7 _ By
li l�_
Bu'r "Otticial Da e
This is to certify th t 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
P R I O R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /Z4 iEL M / e .
NATURE OF WORK a a
USE OF BUILDING
PERMIT NO. DA E ISSUED PIIIWIt
CONTRACTOR PHONE i- 46 C" 1 ,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
IMMO 1 1
1 filiONMENIMM 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 2 �� , 3
INSULATION j
ELECTRICAL l
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST %gI r, I ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING L-,;16—/t3
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 ali 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