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OF PRlp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
F . ; n AND UTILITY CONNECTION PERMIT t .4- .l 3
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+I 1� I . White File
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2 Pink City PERMIT NO. 1 3 I ` c
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3 Yellow Applicant
Please or print and sign at bottom)
ADDRESS ZONING (office use)
■
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER `�, ( p r
(Name) Pt-\r\1\ rc ( �tv 1�� (Ph one) ( 0 C,' - S `1 - 29
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch [Me-Roofing [Me- Siding Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection / e e
CODE: DLR.C. DI.B.C. ❑ Misc.
Type of Construction: I II III IV V A B
Occupancy (:soup: A B E F HI MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5
(excluding land)
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and c3Trect. 1 also certify that 1 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 p�s accordance with submitted plans. I am aware that the building
official can revo>,:e this .ermit fo ust cause- F tithermore, I hereby agree that the city official or a designee may enter tfpon the property to perform needed inspections.
X Oat , . __I. 11,. ` lbI V j 1Z
Signatur: Contractor's License No. ate
Permit Valuation / 6 vv , et, Park Support Fee # $
Permit Fee $ 3 7 S r SAC # $
Plan Check Fee $ .�— Water Meter Size 5/8 "; 1 "; $
State Surcharge $ St Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ —6 ., 73 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 09 V3.
This Application I omes Your Building Permit When Approved Paid e.,/ 9 -? r eipt No. '7U / T /
1 _ ,, -) / 4 ( 3 Date lei . Gf /3.7 Buil 1 fficial 6 Date
( ,, j / , 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
p � + Date Rec'd
i'3 , CITY OF PRIOR LAKE PLUMBING PERMIT
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2 0Z-i
1. $ Fik (PRMIT NO. 4 '3 � 1' Gold City
3. Yellow Applicant
Tlease time or tint and sign at bottom)
ADDRESS ZONING office.)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION ‘C 3,-2k In t s? (L)4 PID
OWNER R l l) .1 5i eA cps 5/hP[,l
(Name) (Phone)
(Address) \c. 3 t2 l - to' i L3 ��/ c„.14
A hi tS7.n ?Lv, ;
APPLICANT � y L . -i 1[, .
(Name) !.: it. _ r ■tr (Phone) (t(a.' a alf S?.q 3
(Address) A. . .. `� .rl _` t
(Address) (City) (Zip Code) • (Contact Person) j t"LA 6 1 el. • (Phone) �___ Wx___
APPLICANT SIGNATURE i .,, DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
i 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
1 Water Closet (Toilet) Other
• • • s • *
P R I R LA K E BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /532 / /LFOS Pe
NATURE OF WORK LOWER., Q / M
USE OF BUILDING RE3'4 IL
PERMIT NO. /T. I/o DATE ISSUED / . * • 13
CONTRACTOR S a!'t Z. PHONE G be. 3 24Z5
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
011111.11111
I I
I I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING Gc.) r,4 J !�
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required) IF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1
FINALS
BUILDING /05,
ELECTRICAL //
PLUMBING
HEATING
DO NOT OCCUPY UNTIL -*=OVE 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