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"44p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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AND UTILITY CONNECTION PERMIT
kovivEsolt• I. White File PERMIT
?. eli City NO. (�,/
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(Please type or print and sign at bottom)
PERMIT ZONING(office use)
- 10
( ( cY
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNE(Name)R N /V ( ( _ tlgi5E f1\)etPhone)
(Address) ,----- As ���
BUILDER \ �p
(Company Name) �c 51
,BG-C I l r (Phone) I%/�Z -447- O 1'"�j
(Contact Name) ` ''--4J (Phone) p(2. -168 - .:5
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-SidingLower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: LR.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (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 :he building
official 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.
Signature Contractor's License No. Date
Permit Valuation , r Park Support Fee # $
Permit Fee $ 62.2-5e SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ I • 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 $ '3. Z.
p C��� i• 21.1�� �_
A.
This A.. ca/I n Becomes Your Building Pe W When ,pproved Paid f Rec rpt No. 5-'
ail,t, ' i .2 Date 1 .1,3• I, BY
• ddina Official Da'
This is to cert' that the request in tht*3bove application and accompanying docu ents i in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed/ tilt- ity Planner constitutes a temporary Certificate of Zoning co pliant and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. 1r
0wt Planning l Zi
e1`
J Special Conditions,if any
hour notice for all tnspec ons(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
ENTOFPRIOR LAKE :21.=
AND INSPECTION
INSPECTION RECORD
SITE ADDRESS -41- t�
NATURE OF WORK f/n�y4ji (4t z-
USE OF BUILDING • r2—
PERMIT NO. I�• DATE I SUED t z t t
CONTRACTOR ;� ( ; j PHONE '4 4 - w
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
DaLINDATIMPrior To Backfill)
ER
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
bStivenvAtetett-eiriC
FRAMING
INSULATION
ELECTRICAL
HEATING
FIREPPLIME
-33PiertngtMR TEST
RDER
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
FINALS
O SODDING) •
UILDING �J .� ,I 1 ,KELECTRICAL �/
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