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' x CITY OF PRIOR LAKE
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K = Z-Final Permitted ❑ Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential 1 ❑ International
" = Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following: i
� Use Classification SINGLE FAMILY Bldg. Permit No. 13 -0165
R3 VN PUSD ,
Occupancy Type Type Construction Zoning District
t Legal Description L30 , B1 HICKORY SHORES SECOND ADDITION i
tl 17049 KENNETT CURVE S. W.
Owner of Building Site Address
Contractor's Name & Address D.R. HORTON , INC.
ROBERT D. HUTCHINS
ity Planner
ui 'ng Official
rte, Date: /O i3 Date:
POST IN CONSPICUOUS PLACE
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CITY OF PRIOR LAKE PLUMBING PERMIT - Z c� / 3
.1:: r
C bsC: J 0)-1 Vir 1. Blue File PERMIT NO . 3 �) /
2. Gold City / aJ . V l
3. Yellow Applicant
ease or print and sign at bottom) 1 A DDRESS ZONING (office use) 1
.- )0 V`f 41/vnitrrewit--- LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N am) R ,Q l- firni-\- (Phone) ( (2 2 90 3 9t
(Address)
APPLICANT 4. / / ,
(Name) ...l 41i it ! , .�!L . AI ■ (Phone) ((1 / VII
(Address) JZ Y2- d UL : 4 iee- 0 6` /Ilk ,)-
(Address) (City) (Zip Cod
(Contact Person) a 06 ./0 (Phone)
APPLICANT SIGNATURE _ Iib_ DATE </
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain ( Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall _ Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family I% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
The Minnesota Statutes § 326B.148 Residential, Additions & Alterations $49.50
"SURCHARGE" has been extended g Building Permit #
The minimum surcharge for a
"fixed fee" permit is $5.00 LUMBING PERMIT FEE $
TATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 1
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid S 7 . > ? Re t J No. 753 Date ([�
Building Official Date 1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372