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04PRI04
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE I��
_.._......... _............_.. AND UTILITY CONNECTION PERMIT 3_17_
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4'NESO
1. White File PERMIT NO. }/+��
2. Deno City /�, Z.ZV
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3513 k.5pba-rl., 1Z;civ. 4 NInd
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ( Sc�
�
(Name) i .(,� (Phone) 07- 308"1 1 17
(Address) 3e.33 Vawart. P-I CI y 6U 1a Pr I(r L lam. 1 Y►'1 IJ 65372-
BUILDER e
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ['Deck ['Porch ['Re-Roofing ['Re-Siding jatower 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 Bto
Occupancy Group: A B E F II I M R SU PROJECT COST/VALUE $ ' 5(X) .
Division: 1 2 3 4 5 (excluding land)
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.
X /,!' At{ ki - 30/16
Signature Contractor's License No. ate
Permit Valuation 000�; ��
r Park Support Fee # $
Permit Fee $ 7� 7-3- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ /. Z Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 57) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ /30, 7,5'
This Application Becomes Your Building Permit When Approved Paid /30, I75*-- Re pt No. j
Date _7 / 7. /a3
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 S.E.,Prior Lake,Minnesota 55372
PRIOR 'DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 3073 4j iz �Q4 �.
NATURE OF WORK `„dw/
USE OF BUILDING a �'
PERMIT NO. /5► • 2.7's E ISSUED S 15'
CONTRACTOR ] �SMJ( / PHONE iii Z 306 7717
INSTALL EROSION CON RT
OL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
F )
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
ft /
FRAMING � ' r.
INSULATION
ELECTRICAL
PLUMBING
HEATING
P E
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COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
FINALS
BUILDING � t;
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