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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
(4.--PRjeTEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z3 /,3
AND UTILITY CONNECTION PERMITI
p L White File /3 ,
+'�..____ 2 Pink city PERMIT NO.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
29'2 (0 800Cfgi -7-72,/q/L— Nvv /eLJ
LEGAL DESCRIPTION(office use only)
LOT/5BLOCK / ADDITION /1//1--0-5 .SOV PID 25 3 82._ O(5, 0
(Name) .) (1, ( f 6-i/I q 6' cs ( (Phone) 412- 13 - 119 (
(Address) 2126 zee ek 4 -fr-4 i ( /✓''t' e'ax` li t i7 " 7`7 2
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction [Deck ['Porch ❑Re-Roofing :!'--Siding clLower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DLR.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5 1
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 eke this permit for st cans Fur hermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
I X % .in. /' �---
Signa ; e Contractor's License No. Date
Permit Valuation 9. 6 0 00 0 Park Support Fee # $
Permit Fee $ / 91 0'5 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ -- C Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 5-,, ? Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ `¢3, 7...-
This
'.This Application Becomes Your Building Permit When Approved Paid I ✓ 7 O ceipt No. 6 e),-.5.21—
Date
�21 Date 1, 2/7"..,% By
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
OSc PRION Date Recd
`411viesel CITY OF PRIOR LAKE PLUMBING PERMIT
apisV
is coria c;ty PERMIT NO. i3_42W-
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
26) 111G44- 1-1-4/( i"'( i
LEGAL DESCRIPTION(office use only)
LOT 1CBLOCK / ADDITION (AJ ( c?S Aid_ \ PID ZS 31'2, oig d
OWNER /)ro1,
(Name) ra p\{ V (Phone) 6 a- �f� ' �9'l`jI
(Address)
APPLICANT )✓: ( '{ - '.
(Name) !' C/eel r (.✓a I—e (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) (Phone) _
APPLICANT SIGNATURE 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
I Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Sink �" u< Lawn Sprinkler
Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit# / 3- 00 415-
PLUMBING
5-
PLUMBING PERMIT FEE $ 1—c-', G�
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 7
(Office Use Only)
This A :ti i :eco es Your Building Permit When Approved Paid Receipt No.
5-9--
ins Officialo B'a , Date BY
c ,../...4.........4.
3/I
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRI R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 2924' gooed9 �
NATURE OF WORK Go 07 ce_v�`Z
USE OF BUILDING
PERMIT NO. /3 - DATE ISSUED /- - /3
CONTRACTOR 6/Ze...�GZ, PHONE 6.a. 4(3. 4 /q
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
41110111.11.111.11111.111.11111116.
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING '/QS/ 5
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
l
FINALS
illiiii.
BUILDING
ELECTRIC "1111111111.11AL
PLUMBING , / /?4/,/3 .
HEATING 2/ 1p// /,
DO NOT OCCUPY UNTIL A • OV 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