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l,F PRlp�P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE vD a 3
x AND UTILITY CONNECTION PERMIT
U lrj
41VNESCl* I. white File PERMIT NO. / ?37 3 Pink Cpp `
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS I 4 1 g d E ICU n 5`t r\ Ave- ZONING(office use)
Prt'o c- Le AAA/ 5 7a_
LEGAL DESCRIPTION(office use only) ZS
LOT BLOCK ADDITION PID Z,? , OC( .C 2-. C
(Name)
Ice Ul K d- .char--o vt S 1 1s'e� (Phone) 6a' �j�� r' I.iOlg
(Address) 61)55" �,.j_^adde—SESk–. ejr'_I L.
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address) q f
TYPE OF WORK 11 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding Lower Level Finish ❑Fireplace
❑Addition DAlteration ['Utility Connection '2—,e,/115.
CODE: ❑I.R.C. ❑I.B.C. ❑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
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 Furthermoi , hereby agre•that the city official or a designee may enter upon the property to perform needed inspectio S.
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X 4,YI I^-'r:i,FA'
Signature Contractor's License No. Date
Permit Valuation L! OU 0 _G a Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ 4. p O Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ ".--61. 5.0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 1731 7
This Application Becomes Your Building Permit When Approved Paid 1/3.-749 Rec:1.4 o. 'Hr
Date Ft /3,_ ( fir
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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS A 1` Ager
NATURE OF WORK
USE OF BUILDI
PERMIT NO. • DATE ISSUED
CONTRACTOR 457760A. PHONE
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
r°11.1"111111111111.111111111.111.1111.11".
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
1111111111111111111111111.111111
FRAMING
INSULATION ((
ELECTRICAL
PLUMBING
HEATING
=11110111110
COVER NO WORK U THE ABOVE HAS BEEN SIGNED
IMMO
FINALS
BUILDING $ IIj'
ELECTRICAL
TRICAL
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