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CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEbULED /p
ADDRESS 1 S � d L.� C� �� • e,� �
OWNER CONTR.
PHONE NO. PERMIT NO. I I" C / c /3
O FOOTING 0 PLUMBING RI ❑ E7UGRAD/FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPlA1NT
� FRAMfNG � WATER HOOKUP O FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
�F1NAL ❑ PLUMBING FINAL � GASLINE AIR TST
� SITE INSPECTION O MECH FlNAI ❑
COMMENTS: (,J� „�,�, c j
�WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
Q CORREC? WO , ALL FOR REINSPECTION BEFORE COVERING
Inspector: OwnedContr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, A Date Rec'd
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� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE •f�' Z Z, //
AND UTILITY CONNECTION PERMIT
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�YjNNESO�D I White File
Z �;�� � PERMIT NO. 3
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS / 5 7 � � 1 o n c�' V�,( (,f �0 Q�/ ZONING (ot�ice use)
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LEGAL DESCRIPTION (oFlf'ice use only)
LOT BLOCK ADDITION PID
OWNER / ' �(
(Name) �L T G � l C/ 1 Q �' (Phone) 5 0 7� 7 7 g' 9 S 3
(Address) �� 7 �� �$ ` 4 n u" 1�� LJ /> C�
BUII,DER THD At- Home Service, Inc,
(Company Name; (Phone)
2690 Cumberland Pkwy, Ste 300 Phone) 95a 3 y S- L o y 7
(Contact Name) _ Atlanta, GA 30339-3913 � f
(Address) Lic # 20268257 Ph. 763/542-8826 J � C�� Gfl Fl�✓��' J 0 n l S
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. �sc. L � W / n`( ��•i /' r p lQ U��/1 S
Type of Constiuction: I II III IV V A B pROJECT COST/VALUE S �`� G �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certi'ty that I have fumished information on this application which is ro the best of my knowledge true and correct. 1 also certify that [ am the owner or authonzed agent for thc
abovamenuoned propctty and that all onstruetion will conform ro all existing state and local laws and will proceed in accordance with submittcd plans. I am aware that the buildmg
ufficial can revoke this permit for just c se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspecti ns.
�oa G g a5� q a� f��
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 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 DUE $
This Application Becomes Your Building Permit When Approved Paid Re t No.
Date B
BuilJim� Ut7icial Date -
This �s to certify that the requcst in the abuve applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. ThYs documcnt
when signed by the City Planner consnmtes a tempurary Certificate of Zoning compliantt and aAows mnstruction tu commence. Before uccupancy, a Ccruficate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-98.50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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