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of PR / ON CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE -, p
tri AND UTILITY CONNECTION PERMIT 8 - `� (• ( Z
~0NNES��r I. White File
Pink City PERMIT NO. /Z _ `06 z4
3 Yellow Applicant
(P1 seuge nr print and sign at bottom)
(ADDRESS 1 .6. 16 s - n k.,_ (oc.. N,,) P^ or L, ( 04 A S 3� 72 ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
Name) 'r l( A c...e.. i•‘ a, (Phone ( 0 1 ' 3 S - 4 - yC2A
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing [Me- Siding .ower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ 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 $
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the hest 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 ust caus'nFurthermor f hereby agree that the city official or a designee may enter upon the property to perform needed inspections
Signature Contractor's License No. Date
Permit Valuation 21 0 00 , 0 0 Park Support Fee # $
Permit Fee $ ep Z ZS SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / G 6 Q Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 39' 5-0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE i $ // 7 L _
This Application Becomes Your Building Permit When Approved Paid jt �t� - . t No. /� �� % I
Date 0i 3 ( z____— � 2 : ' �
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
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /(•26•5 T4H N/ Cr.
NATURE OF WORK LD L
USE OF BUILDING IltPe.
PERMIT NO. / .. 00 DATE ISSUED 1.
CONTRACTOR PHONE 1 6 OZt
NOTE: THIS IS NOT A PER IT FOR ANY OF THE INSPECTIONS BELO
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING �- <1
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
iNINEMMIIMMEMEINIIN
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
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