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44
OrsifPR-4CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT3 2- Itrj
ktivNESO.1P I. White File PERMIT NO. /
2. Pink City /5' /�
3 Yellow Applicant ` / V
(Please type or print and sign at bottom)
ADDRESS1.)1;ictwevd d- �� • 1ror � � ZONING(office use)
.__
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,A ' G ����� ,. ,w
)NameTi (Phone
• 4 .
(Address) t 1 ,,B04NW- Rt,ma tr— 1.....012.4<______,4/
BUILDER 1, _rr -- �((��
(Company Name) (Phone)
�!(T,ur td S (Phone)
(Contact Name) .. . . it - ./_., (Phone) (mal Z ' 3F3/ • tkQ5I 7
(Address)
Noes- eQVY,,,,4 t�.. A P vre Imi.) ✓ S 7aD
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-S c<1 ower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B dt0a-~�
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 1?I
(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 proper hat 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
official can revoket p.�just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform eded inspections.
X to ,s 3C 7 71 3 -3 -15
�� Signature Contractor's License No. Date
Permit Valuation % 660 . 0D Park Support Fee # $
Permit Fee $ 397 15 SAC # $
Plan Check Fee $ 7 _ Water Meter Size 5/8"; 1"; $
State Surcharge $ e n 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 S
This Application Becomes Your Building Permit When Approved Paid 3s L.S Re pt No. 13�I'
Date 3- L,,a- B ,
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
DEPARTMENT OF
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /fig/ Z W/t_.O Woo 0 On
NATURE OF WORK LOWER.- t.g)/E2- f! /ed
USE OF BUILDING `/ /lel/9--/A__
PERMIT NO. /5-, /12_Z DATE ISSUED 2. 2. ht--
CONTRACTOR
4CONTRACTOR M/DW S2-iki, PHONE Cont. 3'7, 57
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
11111111111111
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
arominimmi
FRAMING 'I,) e- ,2
INSULATION
ELECTRICAL
HEATING
11.11111111111114
411111111110.1.0.1.
aiiiiiMMOMMIIIN
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
liiiiiiiiiinik 1111111016
FINALS
BUILDING fi I k
ELECTRICAL
41111166 _
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