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0p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. AND UTILITY CONNECTION PERMIT - -
~N /6
•N � s oO ° ° t. White File PERMIT NO.
3 Yellow Applicant
3 Pink City /// ///fJJ tC.J�h�.�J/J
. - .. - ' . rint and sign at bottom)
ADDRESS ZONING (office use)
5/ a C ao ,, c e43, 1,1,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O ame,)..) DOI Ire 7) 0) p$ 9 (Phone)
(Address)
BUILDE
PCr'O C rr..q v■ et. ( (Phone) .
act am ) 3 '0 \ (Phone) 1 0 2 _
res) l 6 t G 1 k ''(,I CU v� 41/
TYPE OF WORK 0 New Construction ❑Deck ❑Porch DRe- Roofing DRc- Siding er Level Finish 0 Fireplace
DAddition ['Alteration ['Utility Connection
CODE: DI.R.C. DI.B.C. 0 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
I hereby certify that f 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 '.--_- 'se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.. (v
.7. -(
e — Contractor's License Date
Permit Valuation C UC7 C10 ' Park Support Fee # $
Permit Fee $ 6 L 2-c- SAC # $
Plan Check Fee $ — Water Meter Size 5/8"; 1 "; $
State Surcharge $ /- &Z) Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ — ( S) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee f $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ // 7 '75
This Application Becomes Your Building Permit When Approved Paid /17. %5 Receipt ` o 6 7
Date .67/S7L J By -
Building Official Date
This is to certify that 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
PRI0R L DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 5/25 PONDS E hN•
NATURE OF WORK L1WEM
USE OF BUILD!
PERMIT NO. DA E ISSUED
CONTRACTOR _ PHONE 292 4 6
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
ONININ 1 1
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING ? )3
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
MEM
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
° BUILDING
ELECTRICAL 0 olvef:~2�'l
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