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fQeioCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.1.0. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE lB
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AND UTILITY CONNECTION PERMIT //" �-
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44NESOty• L White File PERMIT NO.
----4_,
2 Pink City /..3 Yellow Applicant s 7✓�
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
371/- 77 41L Po )� 7- C 7-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) CA 0 L9 Mo L (Phone) `752- 9 V9--;-0 4-3
Gil- x ')2 -Li 6e3
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing ❑Re-Siding Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection " S/ /`�//) / P.
CODE: DI.R.C. DI.B.C. 0 Misc.
Type of Construction: 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
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 revoke this permit for just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1 X -
Signature Contractor's License No. Date
Permit Valuation 1/ QUO Park Support Fee # $
Permit Fee $ 7 Z.-5—
Jr-- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
State Surcharge $ Z_00 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 51. CV Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ /43. 7,3
6..
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This Applica ',n Becomes Your Building Permit When Approved Paid / J -73-- Rec pt NO.1Q� "a
l�l �C, 13,/3 Date /l /3_ /3 By
. �dineOficial Date
This is to certthat 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
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 3 q// -7LNt t- pa/'1T
NATURE OF WORK �--
USE OF BUILDING /267 ,t—
PERMIT NO. /3 . /z-74- DATE ISSUED /1 /3 . /3
CONTRACTOR Gj -z-0 it-2o E PHONE 141. 5-053
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
1=mt
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING
11101111111
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH
FINALS
BUILDING 1 )/4.9A
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