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PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �' ,/�
7....) AND UTILITY CONNECTION PERMIT
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4jkNEs0'(:' I. white File PERMIT NO.
2. pink City ` � / /
i Yellow Applicant / I
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
.5–,53daSA (AJ
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER "-(' 1/} . ileS _b0 �/�
(Name) 6 o !/ (Phone) 6/Z ?'CI - 9.7/7
(Address) A153 U t I J 5 LA AL
BUILDER ' t
(Company Name) S°X e,- `v'-.0ild a1/4'---. (Phone) an/ 67'6°-1Y"
(Contact Name) J (Phone) / /
(Address) /7,3 0 �,�e ,9 T l io✓1J i- '1 SS/ v
y
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ower Level Finish ❑Fireplace
['Addition DAlteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /9,&0 0
Occupancy Group: A B E F H I M R 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 co -iction 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 revoke this perm : e Furthermore,I hereby agree that the city official or a designee may
enter upon theemproperty to perform needed inspections.
X
2.4I �� / r ^6—/s
I
Signature Contractor's License No. Date
Permit Valuation ,�)) C) Park Support Fee # $
Permit Fee $ ' 34-. 13- SAC # $�
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ * 6
D 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 $ 35 �2
This Application Becomes Your Building Permit When ApprovedPaid ......),--D .Z� eipt No. te✓Z_.
Date 2.-, 6, , i7
`
Building Official Date S.
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. Tins 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
PRIOR LAKE' I EPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS z 003 wI i-OS ( .
NATURE OF WORK 44WVEX_ 145AdOM
USE OF BUILDIN mejlt„ _
PERMIT NO. /„ /19 �► DATE ISSUED Z. (ads-
CONTRACTOR
•f5 CONTRACTOR/WM"AMEX. &O'44 L . PHONE b/Z. aro. 1tS.
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING �-� 2 > jj
INSULATION
ELECTRICAL
HEATING
=MEW
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
0110/111111101/
FINALS
BUILDING _
ELECTRICAL
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