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OF PR /p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
y TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / / / /0
.. x AND UTILITY CONNECTION PERMIT
U tii
M1NNESO1P I white File P ERMIT NO.
2. Pink City /0 1 032
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 LI 5 S Arpck Ioosc, :\ .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) ' / O ciei 1 - R Cf-N G ) \ (Phone)
(Address)
/410, /44,1,,,,,,,....r.-, l., -a.4-* 4
BUILDER {
(Company Name) fl A 1 1/4.0/1 J R.a.1 A - j - t^ Cvv t"-\ (Phone)
(Contact Name) C.X�J�t/� \ / hs VI (Phone)
(Address) 3 t 0 Out. l«—.U0) t/' 1 GC MG t--1 S S' f /Z3
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection 7 V
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: 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--ee�tify that I am the owner or authorized agent for the
above- mentioned property and that a A onstruction 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 rev • thi • f / mit for us - ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X � + oa0'1 (0 0) 7 N /vw 4 / / CJ
Signature Contractor's License o. Date
Permit Valuation 3 U o v ✓ l/) Park Support Fee # $
Permit Fee $ -7q. 7 f--- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / 7 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee , j\r, $ 5'¢ 5 Water Tower Fee # $
Mechanical Permit Fee I`t $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ 51---,5-0 TOTAL DUE $ / 05i Z_
r
This Application Becomes Your Building Permit When Approved Paid 1g' , j eceipt No. 4, (7'7,7
Date ` (• y 2„( 6 ,
Building Official Date
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
RIO
R DEPARTMENT OF
LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /410,6112.00,, $9 Rea/ NATURE OF WORK L
USE OF BUILDING /the.
PERMIT PERMIT NO. M / /GSM DATE ISSUED • I
CONTRACTOR A 1IION'T: !t. PHONE b /. *3#, 1907
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING P4 i t�a�f Y
\ INSULATION "16 1 pz
ELECTRICAL )
,PLUMBING r� /q` O /2Q J�
i HEATING (if required) $ 4 n/29 j4.6
-'� FIREPLACE or /NsIste, E--)
GAS LINE AIR TEST r, dor /110141 -L6° 15.--a'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING 13 14
ELECTRICAL 1
PLUMBING R.A• I )31 4
HEATING 4 4
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.
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