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CITY OF PRIOR LAKE BUILDING PERMIT, Date
/3 te R (a* ec' d
PR TEMPORARY CERTIFICATE OF ZONING COMPLIANCE & - l AND UTILITY CONNECTION PERMIT
1. White Fite
2 Pink City II ( PERMIT NO. I
N6 8 0�� .
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS
a «9; vietal 414/ Sid/ ie/i/ ss 29
LEGAL DESCRIPTION (office use only)
PIDZ . •. 02--- ..0
LOT BLOCK ADDITION p . q g q
OWNER (O /,97 ' !1 < — 3 /
(Name) P j id (Phone)
(Address) /‘ V 93 ceO WAY
BUILDER • C C / LC (Phone) 7f)' SQc�
(Company Name) CC (11^x) U l
(Contact Name) ( t.J C R IVAifi /� (Phone)
(Address) Z) & ap/✓PtU- Ctrs Ah Away" 60( 11/A1 SW y9
TYPE OF WORK 0 New Construction [Deck ❑Porch ❑Re- Roofing ❑Re- Siding Gower Level Fipi ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection / - _> J J
CODE: ❑LR.C. EILB.C. ❑ Misc. dV
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ _ �! -- --
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby above- menti ed p have a furnished d that all information
onstruction will onform all existing state and local laws and will proceed n dancfwi with submitted owner
d plan I am authorized
ware that the building
official can ok this t for Just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
3436 / /`
X L Date
Signature
Contractor's License No.
Permit Valuation
� � 000 ° 0 Park Support Fee # $
Permit Fee
$ 7z6 ?5— SAC # $
Plan Check Fee
$ _ Water Meter Size 5/8 "; 1 "; $
$
State Surcharge $ Pressure Reducer
/ Sewer /Water Connection Fee # $
Penalty $
Plumbing Permit Fee Lr —7
$ /� Water Tower Fee # $
(.�
Mechanical Permit Fee $ // Builder's Deposit $
Sewer & Water Permit Fee $ /30
�� Other $ Gas Fireplace Permit Fee $ TOTAL DUE 7 $ 'f 5
g Approved /J O. Is' e ipt No. CO 73
This Application Becomes Your Building Permit When A proved Date a ..lf-6 _
Building Official Date
whhen s e is ig to c ned ertif
byyt the City request lnner in the above application and
constitutes a temporary Certificate of Zoning e compliance and construction to commence. Before occupancy, 1 a Certificate uoftOccupancytrmu document
wigd by City
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
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /041 .SAC
NATURE OF WORK
USE OF BUILD1 W ,
PERMIT NO. DATE ISSUED `I O
CONTRACTOR • PHONE • ui • $f
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT
ALL TIES
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
S vc
FRAMING /D, �/4
INSULATION
ELECTRICAL
PLUMBING
HEATING
IMINIMMENIKIN
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH 1 1
FINALS
= LDING it
ELECTRICAL
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