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of PRIpd CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
it t.; TEMPORARY CERTIFICATE ZONING COMPLIANCE z Z ¢ t a
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AND UTILITY CONNECTIONOF PERMIT
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Min'NESO_P I. white File
2. Pink City PERMIT NO./0 0 0 /
3 Yellow Applicant I' V
(Please type or print and sign at bottom)
ADDRESS` cS )--� Ly\ S P Lc-'‘t ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
. G0
(Comp(Company
) \ y C c—\\ i\r,� t i-QptUI\ .. Z--eiviDd61 (phone)3do- \ >A:DCom an Name
(Contact Name)j .—"K—CP"--) ` •JJ (Phone)
(Address) CIO c- S \\L--\( kR C,rC 4 4_p\Res rvvt) S W (f
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
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 r- - .ermit f. )nr c�-urthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed insp�ons.
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ Z-51
S 0 0 SAC # $
Plan Check Fee $ /4 2. 5- Water Meter Size 5/8"; 1"; $
State Surcharge $ SZ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ .50. 0 Q Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ?i 75-
This Applicata,/ : c Imes Your Building Permit When Approved Paid g� 7S ReCel NO. .574 z(o
Date Z.. pfr,. ( a By
.if I/ Z, Z-4--; (0
Bi/ding Official Date
This is to certi 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
p RIO CITY OF PRIOR LAKE Date Rec'd
�1 HEATING/AIR CONDITIONING/FIREPLACE PERMIT 3. 3 . 16
kjN1VE5 cio 12.G.Pinkreen Filtye PERMIT NO./v /G
Ci �� /
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/5)37 t 7f Pay
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION - PID
OWNER
(Name) (Phone)
(Address)
(Name)CAN V 4e_c,Cant L4,1 .10-40 (Phone) 163' ?'e4'' 4,57 f
(Address) 149 sj 1-70+1' LA) /1/M,. - 4NDoL' $ ìo y
(Address) (City) (Zip Code)
(Contact Person)'Ota e.`//db- 6611 ,
(Phone) �3"
APPLICANT SIGNATURE DATE 3.--3-10
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
❑Air Conditioning 0 Special Devices
[Went.System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
F3 MODEL illi✓(-j a U/'et i' -
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace $49.50
$49.50 minimum
Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Estimated Cost$ Building Permit #
HEATING PERMIT FEE $ (i. s
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ _7,---e)-1.,e....>
(Office Use Only) '7
This Application Becomes Your Building Permit When Approved Paid 5D G,d e jPtNo. c_/
Date3 3 w B
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /55.31 1'Ya,,O.r ACM/
TYPE OF WORK /uff. /g
USE OF BUILDING /,LJ 4f#c1
PERMIT NO. /0. 004/ DATE ISSUED Z. 2*. jO
BUILDER "a71694/ "Par via PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR • DATE
.1 - Vo(/ S 4V I �
PLACE NO CON ETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING
I FINAL
"'�' FOR ALL INSPECTIONS (952) 447-9850
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