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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
( (PR,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1J ?
.. n AND UTILITY CONNECTION PERMIT
7 7/ U I r j
5r3
kikivHSOlh I. While File I
2 Pink City PERMIT NO. %? 76 —c
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
� y � gy>pp ,�A
LOT (Q BLOCK / ADDITION /r�'E' 4 ' -5 �0l2=th /f/ ' - 1 % 5 PID I"'� ,J,y- Ls °
OWNER )
(Name) Q �� / u , (Phone)
(Address) /6 /5-3 _' e /'¢1i,%2,s4 V /1 Pr'' 'lam ,q ke 77
%= W te � i
P X
BUILDER
(Company Nam ' , .-�P/e , c,r�, rr (Phone) C // ate � ''
(Contact Name) . _ .' (Phone) 6/.. .- 71.2g'
(Address) l /.S'S'r ,1 '7't.. IC s /i4 /mi /19,1 4'5
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
Addition ❑Alteration ❑ Utility Connection
CODE: 7.4LR.C. ❑I.B.C. ❑ Misc. _—
Type of I on q coon: I II III TV V AB PROJECT COST /VALUE $ 3f (VC C
Occupan Group: A B E F HI MR S U (excluding land) ■
Division: 1 2 3 4 5
1 hereby certify that 1 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. 1 am aware that the building
official can rev ke this r t cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed Inspections.
X J e . . /P / c & 3 5 9 .- o r /3
Signature
Contractor's License No. Date
Permit Valuation '� 0 00, Park Support Fee # $
Permit Fee $ 41' SAC # $
Plan Check Fee $ 3 i ` t Water Meter Size 5/8 "; I "; $
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 n --7,/&,/3 $ S 2 ( , 1 S
This Application Becomes Your Building Permit When Approved Paid ` / ceipt No. 644 fl
Date 7 .2,2,if _
Building Official Date
This is to certify that the r quest in t /., above application and accompanying do uments is - accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed the City ' l ' ner cif stitutes a temporary Certificate of Zoning omplianc and allows construction to commence. Before occupancy, a Certificate nt' Occupancy must be
issued // �/ r
i' 1
Planning D 'ector ()a e Special Conditions, if any
24 hour notice or all inspections (952) 447 - 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
P R I R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS I 7H di'r►
NATURE OF WORK • •
USE OF BUILDIN .'.� -z
PERMIT NO. , .,,t41 DATE IS UED A t
CONTRACTOR L� � �._ PHONE I +-wise
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELO
THE PERMIT IS BY SEPARATE DOCUMENT
INFECTOR 9ATE
I FOOTING 1 1
FOUNDATION (Prior to Backfill) , r/ " "��1,21■
PLACE NO CONCRETE UN," HAS BEE SI NED
ROUGH - INS
sommorsoNIPPIIMMIND
FRAMING
INSULATION
ELECTRICAL
TLUtIB11106
HEATING (if required) q' r /2
III
o ffliammeimakerara
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I 4- SeriAY/2A1P ci
FIN ALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
HEATING /0Z/
1_ /t / 3
DO NOT OCCUPY UNTIL A511:CYCHAS 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