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o f PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 8 ��
v li
4"' ' I. White File
2 Pink City PERMIT NO. /3 / Z1
.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
: 7/ 2.__— i'a idri, S
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER , t
(Name) , .e ry l � t S _ � » .P_ ( G- -- (Phone)
(Address)
BUILDER 4 r—
(Company Name) 1 1 LL `_ - t (Phone) 9 d ry •� y
(Contact Name) 1, 6 / (Phone)
(Address) r - 4 � J • E , / 2
TYPE OF WORK 0 New Construction ❑Deck ❑Porch DRe- Roofing DRe- Siding Lower Level Finish 0 Fireplace
DAddition ❑Alteration DUtility Connection ,7 A
CODE: DI.R.C. DI.B.C. 0 Misc. // F- /"
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A BE F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 by certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
abo tinned p`1. 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
officia can yoke thi it for just cause. Furthermore, I hereby agree that the city official r a designee may enter u the ro i
erty to perform ne eded nsp • [ions.
X . C. 3 ' 71� it / i 3
`m— - Signature Contractor's License No Da e
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 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 $ TOTAL DUE $ / $4 15
This Application Becomes Your Building Permit When Approved Paid 1 f 0, 1,j R ipt No. -t3PP
Date / /•, 7_ (f
Bui'dine. 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
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY: / Date: 7/. 7, (3
Building Permit # /, f z_cri PID: Zoning:
Site Address 2-7 / P 6 % 7V1-1:f
Legal: L B Subdivision:
Existing Structure: ES r NO
CONFORMS TO ZONING YE! NO
ORDINANCE
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? •f
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single 1/
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L: \TEMPLATE\ALTCHCK.DOC
PRIOR LAKE DEPARNT Or i
BULDING TME AND SPECTION
INSPECTION RECORD
SITE ADDRESS 3 l A95f
NATURE OF WORK ` K7e.
T
USE OF BUILDING
PERMIT NO. ISSUED
CONTRACTOR 4 /4p� e Aflx,.. PHONE (O /L. 4051
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
ailaggiNaMMOMININa
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
Luc
ELECTRICAL
PLUMBING
HEATING
=Ma
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH I
FINALS
BUILDING (z A;
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