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OF PR.ro CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /' . / /
AND UTILITY CONNECTION PERMIT
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l. I. White File PERMIT NO. /4. //3
��A'NESo� 3 pink Airy
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
48°.-1- M ..f- ' e AAL) , PR o 2A-kF) NA) -s 3.1-
LEGA``L DESCRIPTION�j (office use only) Xe
`I „
LOT(0 BLOCKS ADDITION Gam/Z0,41
S iZAj PID �5 V 04”
OWNER ��/ 2 - �7�'!� -3
(Name) ! �6/G?//� S ���� (Phone)
(Address) ,gqe)b 16t- 7,,,,t MA) , f'R-zo R Mk ) Ai A) ..;Tc-3,7-2
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ORe-Roofing ORe-Siding Aower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection , /N1/—S.
CODE: 11I.R.C. ❑I.B.C. 1=]Misc.
Type of Construction: I II III IV V A BPROJECT COST/VALUE $
Occupancy Group: ABE 1 2 3 4 5 SU
(excluding land)
Division:
I hereby certify that I have burnished 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 revoke this permit for use. Furt I hereby agree that the city official or a designee may enter upon the property to perform nec c r . coons.
X ( /eV"
Signature
Contractor's License No. Date
Permit Valuation 3t 0 OC) . 0 Park Support Fee # $
Permit Fee $ /II/ 7s SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ ! c7- Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 3-" Water Tower Fee # $
Mechanical Permit Fee $ � Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ M TOTAL DUE $1�V, I ,
This Application Becomes Your Building Permit When Approved Paid /30, 75--- R ipt No.` e .
Date /C).,,/
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'
ADDRESSINSPECTION RECOR lif
® r 3_0, �`-„a, 77410/40PN 'SITE ,r,/ 7-'7 J� 1
NATURE OF WORK ''� /�'�'
USE OF BUILDI ),_, F
PERMIT NO. AWLS,' T� DATE ISSUED PAM IfL, `
CONTRACTOR It'�r r�l_ � r� PHONE r
'
INSTALL EROSIO CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
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1400.11111=11111111111R ig". I)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SfiiirMrc
FRAMING f) 8 1 D 2' t"
INSULATION
ELECTRICAL -
PLUMBING W C
HEATING LJG
NM's I
-
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
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FINALS
GiiiiiiiMONNINUMNIMIG)
BUILDING ......
1 /(12(et'i
ELECTRICAL
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