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�F ratio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE l 21 G/-
fel AND UTILITY CONNECTION PERMIT
krkivesolik I. White File
2. Pink City PERMIT NO./4...
i4
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS `�_; ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ����� : , �U Phone) >ame
-/5^o— 3)3 —r C23?-
(Address) /6'7 �(/lf1464 e cr Late r/- r t b(f Zet � i 4Z( . .Y-11.,
&
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck DPorch ORe-Roofing ORe-Siding Jwer Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection ( �i _
CODE: DI.R.C. DLB.C. 0 Misc. 3
lein% �o r P` ��- _Y
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
(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 agent for the
above-mentioned property and th!...6 Ii const-uct'• A ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware th t the ilding
official can revoke this pe at'fo lirir cause) . .re, -reby agree that the city official or a designee may enter upon the property to perform needed inspections. �j /
i.
x 41111IAMBIPP
Contractor's License No. Dae
Permit Valuation 3 o 0 a U 6 Park Support Fee # $
Permit Fee $ , ¢ 7,T' SAC # $
Plan Check Fee $ — Water Meter Size 5/8"; 1"; $
State Surcharge $ /r 3 Pressure Reducer $
Penalty $ ! Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 54--50 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee I $ TOTAL DUE $/3 ) d 7 1
This A licat't "'—
This
717/ 7
pp q Becomes Your Building Permit When Approved Paid /./.0.'jS R ipt NO.
:'/ Date A2j'/`i
.t (ding 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. 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 Occupar.cy 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
PRIOR LAKE RMENT OF
BUILDEPADINGTAND INSPECTION
INSPECTION RECORD
SITE ADDRESS /NttrQi, god
NATURE OF WORK .A":/171 _ 3 USE OF BUILDI G
PERMIT NO. • DATE ISSUED • , -
CONTRACTOR PHONE M. W . W
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
ill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING _
INSULATION
ELECTRICAL
PLUMBING
HEATING
SNE
COVER NO WORK UNTIL THE ABOVE H BEEN SIGNED
FINALS
.BUILDING \`tr 15
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
L $ LU