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of PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
41
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,
AND UTILITY CONNECTION PERMIT �,_ Ci . I Lf
44/pEgOlP I. White File
2. Pink City PERMIT NO. (.,,
3 Yellow Applicant ` l _(/
(Please type or print and sign at bottom)
ADDRESSZONING lofhce use)
1 ��Q 51r RE" I 141 e--- 13 2
LEGAL DESCRIPTION(office use only) -
`� %71s 4:- : -,t-..22 S C;4 - -d7/27 c k L::S 41)6' A
LOT BOCK ADDITION PID • 5- Cle). -i7 2e:9.- e
OWNER
(Name) M)' c c0/-fl CCC (Phone) �/2- -9.SS - 0705
(Address) 4U,',;.,//t7- /..Asi( Yc,p
BUILDER A
(Company Name) Ai\ C g/fi-ItNfra)th t-,+S (Phone) 76.3-9-39—y10-6
(Contact Name) - to fr's (3`-N (Phone)
(Address) 7 3 cc„--/-1 /71e41 I ... C. '5 11/4/ C S y 3 3
TYPE OF WORK ❑New Construction ['Deck ❑Porch ['Re-Roofing ❑Re-Siding ;,<Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑LR.C. ❑LB.C, ❑Misc.,4 3 1jzckz;`• fp IOLA, It✓r (
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /0�°CD
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 atent 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 r ke is p rmit for just cause. Furthermore,I hereby agree that the city official ora designee may enter upon the property to perform needed inspections.
x 66C3szor 7- 9- 1Y
Signature Contractor's License No. Date
Permit Valuation 3 QQ_Oa Park Support Fee # $
Permit Fee $ 8 0 _2 SAC # $
CJ
Plan Check Fee $ `S 3(0 Water Meter Size 5/8"; 1"; $
State Surcharge $ / –z) Pressure Reducer $
Penalty $ V 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 $14—i I ( r
This App icati: :ecomes Your Building Permit When Approved Paid /4.1, I1 Rece No. '� /
il 1 g Date 9.,/ By
Bui in Official Date
t
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
P I LAKE
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS / 4 <-57. Witt- My
NATURE OF WORK / � / p-7 //t/ f4Gt/ )t 1/4/1.-6i
USE OF BUILDING
PERMIT NO. i . DATE ISSUED 7- 9
CONTRACTOR G� (L- 4 /II/9/tev&rl - PHONE -7(0..? , +6' 1 . `� 2 0
INSTALL EROSION CONR OL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
4111111111111111111111 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 13EDR A1`).1) WINDOW is( H.
INSULATION
ELECTRICAL -
HEATING b ( S1 1 y
1 � 1
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
Itiiiiallie LATH
FINALS
B ILDING (
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