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o4 PRl CITY OF PRIOR LAKE BUILDING PERMIT, Date Ree'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
NM WIP
AND UTILITY CONNECTION PERMIT
U . ttl
4114NBS01 ' I, white File PERMIT NO .
2 pink City ( Z . 1 �( L0
3 Yellow Applicant
Please or print and sign at bottom)
ADDRESS . (office use)
/ yge e7 (y' ems( 60. e " , ^
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �� & (Phone) r52-2./ d '` g, ` 3
(Name) er
(Address) /'' l &2ex / e4 , /l' c „,- . /r/� -
BUILDER 7: (Company Name) er 5 t& (Phone) 757 'g/ 5 7 4
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch [Me-Roofing ['Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: I 2 3 4 5
I hereby certify that I have hurnished information on this application which is to the best of my knowledge true and correct. I also certify that t 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 revo this permit for ju •t cau�thermore, I he •eby agree that the city official or a designee may enter upon the property to perform needed inspections. ew
Signature Contractor's License No. Date
Permit Valuation c(120 — Park Support Fee # $
Permit Fee $ 25. SAC # $
Plan Check FT $ ( Co , Z c Water Meter Size 5/8 "; I"; $
State Surcharl;e $ 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 l $ TOTAL DUE $ . _ - 5
x
This A . ati ■ Becomes Your Building Permit Wh proved Paid K - � � 1, � Receipt No. & 13 /-
1 ' 4 1 ' _ Z i t . 11i Date 1 7,.../3 A 7� By p V
uLtit Official Dat
This is to certify tut 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 lanner con note tem. rary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
dii1V / /0.7 1 7 1 - /02
'Y PI g 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 (
4
NATURE OF WORK ' -r-`" o Rain Ex- • • A—A,
USE OF OF BUILDING •'
PERMIT NO. ( - - « z- ° D A T E ISSUED 1 4 (
CONTRACTOR 'Co MA S t om - PHONE " - - & (43
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
[9OTING 1 1
- .:.1..-- , *. s:. °r#n 4oBa 11�
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER1WATERTSEPTIC 1
�FRAM1NG�
- IN ATION
ELECTRICAL
�-- -PLUMB NG °-
--- - HEAT-I NG if required) -
FIREPLACE
-GAS
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
--- -G�tAB rior o odding
BUILDING V� l�/1I�)
ELECTRICAL c c `
- 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