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OF pttto� //CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 6` /
AND UTILITY CONNECTION PERMIT
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�y.�N ote I. white Ci
2. Pink City PERMIT NO. ii /33 3
MBS
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
10- 15 RL.)YJ1 LAKE TEPA 1L_ SE
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Z - i) �,� Zt-F
(Name) 6 Rs 6 6o 8 L 1 R S C N (Phone) 152 O -
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing ORe-Siding lower Level Finish 0 Fireplace
❑Addition ['Alteration ['Utility Connection - Ps-t 15 .
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 c1 revoke this ermit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
A , , ) 1- 6 — )2.
IX
ilf Signature Contractor's License No. Date
Permit Valuation 7–( b00 • 6 0 Park Support Fee # $
Permit Fee $ UI 25 SAC # $
Plan Check Fee $ _ — Water Meter Size 5/8"; 1"; $
State Surcharge $ I. 00 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 l $ TOTAL DUE $ (!l 3 JE
This plication Becomes YourBuilding Permit When Approved Paid C 0S 1") Receipt No. (4.---,(0/ .
�9�" ` Date (f - /Y By 71.--c-.4-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
PRIOR LAKE BUIDgPARTMENT OF DUNG AND INSPECTION
INSPECTION R
SITE ADDRESS 1(17/15. 8t/N0 i01,40 -
NATURE OF WORK i°014#12,0 e' -
USE OF BUILDING A -
PERMIT NO. / 2 . /333 DATE ISSUED /1. 6 ./ Z'
CONTRACTOR 405taitsedi PHONE 440 . 672*
NOTE: THIS IS NOT PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
000•111111111.00
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 67 2/5 J/r _
INSULATION
ELECTRICAL LJ -
HEATING (if required) _
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
affilitHatiMMORM
F UILDING \ 2 rctl1 J _
ELECTRICAL _,
ORM 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