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(De i PR.% CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE g__ /a /3
en AND UTILITY CONNECTION PERMIT
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D . 2.--7S/ 1. White File P ERMIT NO.
gill City _ q93
3
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 s! 6 r:5, S, S_ w.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) _° S c. t C e ( I (Phone) C 14 - S 1 1 . _ 6 4 S'
(Address) 3 3 c 1 G... S y s SA _- W
BUILDER
(Company Name)' e k • (.1.)L, 1 1 .‘) r r Ca: ,, S i f.1 r 1 ; -. Z..‘ k (Phone) (t - - S - ' i - C 1 r
(Contact Name) (Phone)
(Address) 33s, 6_ r. S g r S 4 . S, w- jet ..r L a k Z. A'!r -SS ) 7.
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe- Roofing ORe- Siding Gower Level Finish 0 Fireplace
DAddition ❑Alteration ❑Utility Connection .4---1_,Alf
CODE: DI.R.C. DI.B.C. 0 Misc. `iJ6 AP .-
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ 1 S a 0 0
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I 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 in accordance with submitted plans. I am aware that the building
offi can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. 9,
Signature Contractor's License No. Date
Permit Valuation ` 0O G - C 3 Park Support Fee # $
Permit Fee $ '7 7) SAC # $
Plan Check Fee $ ,,.....— Water Meter Size 5/8 "; I"; $
State Surcharge $ J?) Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ <-44 �"Z Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $ AIO , C
Gas Fireplace Permit Fee $ TOTAL DUE 9
This Application Becomes Your Building Permit When Approved Paid /; 0.. - Rece No. CC -'--
Date 9 /Z,,l) By
a
Building Official 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
4 p R10 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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£i9-
4,4NEsoo
I. B lue File Z
2. a md �;t PERMIT NO. /3 -
3. Yellow Applicant t
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
331 Cir-`b95 S� ., --
LEGAL DESCRIPTION (office use only) J- �-�i
LOT BLOCK ADDITION PM 05 4 " �';
OWNER
(Name) ' J (XS OY- 1 -C ,C (Phone)
(Address) L oZ oq S\
APPLICANT—, tt �1��11
(Name) (UIf / V'VL(} -P f (V A 1 (Phone) (-0S — 62 ? -- (06:21
(Address) 3qq L '4'11 17 S l t 1/G,fn.c c.(
(Address) ` (City) (Zip Code)
(Contact Person) `/ LC. I AlA (Phone)
____I_Z/Z_/j,3
APPLICANT SIGNATURE G _ _ 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 l% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 $ _ Building Permit #
"SURCHARGE" has been extended
The minimum surcharge for a PLUMBING PERMIT FEE $ PAID WITH
"fixed fee" permit is $$.00 STATE SURCHARGE $ _42P UI DING PERMIT
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date I / By Tit
Building Official Date I
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
taEPARTM OF
P R 1 R LAKE BUILDING AND ENT INSPECTION
INSPECTION
RECORD
SITE ADDRESS 335/ S •
NATURE OF WORK LDI�V l�L.
USE OF BUILDING /i
PERMIT NO. DA E IS UED
CONTRACTOR ABoL ' PHONE /Z. 6 8 _ L►e
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
OMER I
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 1/ , /-2- 3/7
INSULATION 1y�- / 1
ELECTRICAL
PLUMBING / (0/,;///,
HEATING (if required) 473/,3
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1
FINALS
BUILDING `�i /
ELECTRICAL
P LUMBING
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