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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
t:AN5._
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /`;-_
AND UTILITY CONNECTION PERMIT �'
r�'NES��
I. White File PERMIT NO.
2. Pink City
04.•
3. Yellow Applicant /4,
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
14 os 3 1-Ims (a .E.. Cl t2. .
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Dace
4 S ISS`( THD/ .5(Nam (Phone)
•
(Address) 14053 A' LA Kr- ((Q..
BUILDER
(Company Name) �?ZLAcFF �a -c /NC (Phone) S2' p I8 S-417
s
(Contact Name) 3014 ell'+ -11-L (Phone) 9 5 4Si_4'437 jy
(Address) Z1 4 83 (.44051AA AvE. Lfit1cf.vi'-''- vi'-c-:_
TYPE OF WORK 0 New Construction ❑Deck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish El Fireplace
DAddition ,iteration 0 Utility Connection (��
CODE: I.R.C. ❑I.B.C. ❑Misc: �^TIA 2'FMclos1'-
Type of Construction: I II III IV V AB 50 O00
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ l
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-me,ioned 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 Al evok is,,s.. -r just cause. Furthermore,I hereby agree that the city official a�designee may enter upon the property to perform needed igspectiorts.
X I �(0 3 0 7(/�9�i
Signature Contractor's License No. Date
Permit Valuation 9Q Park Support Fee # $
Permit Fee $ '2)4-' SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ ;b Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $ '
Plumbing Permit Fee $ 5-0 Water Tower Fee #
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other ,,�J(% $
Gas Fireplace Permit Fee $ TOTAL DUE
edfi " 7`/6 t' $ g(i l
ThisAp riati, ecomesYourBuildingPermitWh Appr.vedt�1�. _ Receipt No /� i g
`� P ate By ��
7 /4as, ( Q�` U I ` A
• ,•Official Date C
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. Thi;: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 S.E.,Prior Lake,Minnesota 55372
DEPARTMENT
PRIOR LAKE BUILDING ANDOF INSPECTION
INSPECTION RECORD
SITE ADDRESMItS,Idirs&
NATURE OF WORK �
USE OF BUILD —
PERMIT NO. `,' BATE ISSUED Aff -
CONTRACTOR .� rariL1PHONE Y L 37
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREE S AT ALL TIMES
INSPECTOR DATE
#11181/Majni&---
111111111111111116
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 0 , L J ILI
INSULATION I
ELECTRICAL
PLUMBING
HEATING ( „7
0111111111111111111.
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
01111111111.11 1111011111111111.
FINALS
BUILDING �jSi�,/
• ELECTRICAL —'
s PLUMBING
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