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tvitto CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'dTEMPORARY CERTIFICATE OF ZONING COMPLIANCE / /Z t13
�jAND UTILITY CONNECTION PERMIT
~/NNEsOle. I. White File
2. Pink City PERMIT NO. /3 /Z67
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
14si 230 ' }k:3= VP\ LZ— N
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 1 illy M S Se ROL,02._ (Phone) t t Z- 9 46 - 5 $-f'2
(Address) ) (e-L^y c Tih Fes, -t- /•.,
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address) •
TYPE OF WORK 0 New Construction ❑Deck ❑Porch [Me-Roofing ORe-Siding ower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.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 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. ••,t f• . cause. Furthereinve$hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
ignature Contractor's License No. Date
Permit Valuation // 00 0, 00 Park Support Fee # $
Permit Fee $ 3 (4—. 75 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge 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 $ '? ^
This Application Becomes Your Building Permit When Approved Paid �� i�
ipt No. ;ffa
Date / Z, /3
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 nd 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
P R'O
R
LA KE DEPARTMENT
AR
TMENT OF
BUILDING
AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /b 06.7k4 /NATURE OF WORK / A
USE OF BUILDI
PERMIT NO. « I 4 DATE ISSUED 1/. IL
CONTRACTOR S-. PHONE b/Z. 9W_,,,Vay2°
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
4U1110
I � I
PLACE NO CONCRE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
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