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04 PRI0� Date Rec'd.
CITY OF PRIOR LAKE PLUMBING PERMIT •. 6z. / c�
ai, e
nl< PERMIT NO.
3.Yld Applicant ►" Woo
3.Yellow
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
14(7 3 �M�pr.e MAA ( 5F ISD
LEGAL DESCRIPTION(office use only) / !f f n •
LOTi BLOCK ADDITION'OM L1�I C`� Lit) �(YiIV Pm L 5 � ' C�o��G
OWNER ✓11 ,/�
(Name) i l r cJ< 1 L�,U b lieuec (Phone)
(Address)
APPLICANT,
(Name) 1�n c_ (Phone) /4e/. "-Er/o7 -EDS-2
(Address) L 2 3 ' Pe rty j 4 f) - Se') gi c [elr,L s5 —
(Address) (City) (Zip Code)
(Contact Person) ajr - (Phone) (o/e=2
APPLICANT SIGNATURE II' il 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) / Others
FEE SCHEDULE
Tile Minnesota Statute-s-§- f 326B.1'48 joli cost with a$49.50 minimum Residential,New One&rwo-Family $149.50
"SURCHARGE"has been extended Residential,Additions&Alterations $49.50
The minlniuin surcharge for a •
"fixed fee"permit is$5.00 $ Building Permit#
•PLUMBING PERMIT FEE $ 1-11.50
STATE SURCHARGE $ X14 5.00
TOTAL PERMIT FEE $
(Office Use Only) •
This Application Becomes Your Building Permit When Approved 41EM5T q Receipt No. 7/,L l
Date By '
Buntline Official Date �" - ( j A c
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
OF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date P:ec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ¢ 30
AND UTILITY CONNECTION PERMIT
yt�yNE$pK�' I. White File
3 e l City PERMIT NO. //L/ ��
3 Yellow Applicant `"� // v
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
k Lk 1-Ct 5 1 V\CLR\Q:\\? ‘--. a—
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER IV rc.. A t5\.u., ^� \\Qv- o..v-9._..\(` (Phone) CA2• -ICSS- 2-2-1 1
(Address) 1 H 1ckS MC3v\Q- -1-Q1 L. 5E
BUILDER
(Company Name) (Phone) _
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Constr, ction ❑Deck ❑Porch ORe-Roofing Lower Level Finish 0 Fireplace
❑Addition Alteration ❑Utility Connection
CODE: ❑LR.C. ❑LB.C. /N the„ ymisc. DOOflS _
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /000. Od
Occupancy Group: A B E F HI MR SU
Division: 1 2 3 4 5 (excluding land)
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
official can revoke this permit for just use Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X i/�d�r 'bilk _
Contractor's License No. Date
Permit Valuation 7 000, Park Support Fee # $
Permit Fee $ /47,Zj SAC # $
Plan Check Fee $ Cj�',-1( Water Meter Size 5/8"; 1"; $
State Surcharge $ 113-cr, 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 .. $ 'Z,9.. ,.
G ,, / / '
This Ap;ii
a ' BecomesZour Building Permit Approved Paid "'��"` �. . LI. Recei lit No. G( Date G.2 . (k` BY W1,W
acral Da e
This is to certify that the que. in the above application and accompanying docume s i in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ci an constitutes a temporary Certificate of Zoning comp anc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
.TM
issued. a__ S CY"-M(T
Eos
Planning for to Specialonditions,if any
24 hour no ice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS k kieic tlAPC-b' ' RAIL, - e
NATURE OF WORK ( 06z. AL -Ee".r ,,l\1e1.0 LA4 496.6&0), g fr-- -5_ giro
USE OF BUILDING tz /Vie— c .c
PERMIT NO. (4-240DATE ISSUED ,i /4
CONTRACTOR II t c -S Ne u�- PHONE z,r 71,E-Zu I_
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
41WPrior To Backfill)
Irl110uWIER
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
411.111111
FRAMING (, 12)11P-.1
INSULATION '9-a-c_.- C,1t.t-t / c.
ELECTRICAL
PLUMBING 11 G/f/- _
MINIIII ,-14:)-t_c_., 60-41 l i Li
T
COVER NO WORK NTIL THE ABOVE HAS BEEN SIGNED
HOUSEWRAP ni ,fe;6 a LATH
/ FINALS
PRIOR TO SODDING) .
BUILDING
ELECTRICAL
PLUMBING (Jrc U� �, g,/s .
er
CS2el- ,Si/e--
DO NOT OCCUPY UNTIL ABOVE HAS B EN SIGN D
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