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fPR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
M TEMPORARY CERTIFICATE OF ZONING COMPLIANCE (a_ , w �¢
AND UTILITY CONNECTION PERMIT _//
4//'N6 s0i� L White File
z Pink City PERMIT NO. 4_ OZ 3 Yellow Applicant / ! l LI
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/'78q -77/1')8ERWoLf -n ' MA) Pup
LEGAL DESCRIPTION(office use only) -
LOT BLOCK ADDITION PID 25- 3&3 02-3 0
OWNER B4.41 A- Sc 1 (,4k (Phone) 952 -855 -93
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) • (Phone)
(Address)
TYPE OF WORK El New Construction ['Deckj Porch'❑Re -Roofing ['Re-Siding OLower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: R.C. ❑I.B.C. ElMisc.
Type of onstruction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
1 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 c use Furthermore,I hereby agree t•.t th city official or a designee may enter upon the property to perform needed inspections.
Si: .- f Contractor's License No. Da e
Permit Valuation Zd c c",- Park Support Fee # $
Permit Fee $ Z 3.Z'S SAC # $
Plan Check Fee $ 47.1 at. Water Meter Size 5/8"; 1"; $
State Surcharge $ t 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 Aim& 9, 16 14-- $ (ZZ t 40
This Application : omes Your Building Permit Wh Appro -d Paid /Zj.0 Re pt No.�2z
§1R
Date 9, , /r B _
1► 1J�
......,
• , ,.l `
Buil 'iiirir Date
This is to certify that the request in the above application and accompanying do ments is in- cordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by e C y •tanner constitutes a temporary Certificate of Zoning'ompliance d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
N Planning Director �._` Army Date Special Conditions,if any
-7"1" , notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
PRIOR LAKE RNT O
BUILDEPADINGTMEAND INF
SPECTION
INSPECTION RECORD
SITE ADDRESS 4; ' 1 gf IwitoG
NATURE OF WORK
USE OF BUILDING
PERMIT NO. [%l' DATE ISSUED , . •
CONTRACTOR -1q4f'l1,VAi T PHONE iv L?
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
FOOTING
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMINGt
INSULATION o a G l
��
i
ELECTRICAL 1
.11111111111
410111111.
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
FINALS
BUILDING
ELECTRICAL
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