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of PR% ' CITY OF PRIOR LAKE BUILDING PERMIT,
0
40 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
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AND UTILITY CONNECTION PERMIT /!' /0
tINNE sO��
I. WhitePink FileCty
PERMIT NO.
3 i0I /��
(Please a or .Tint and si n at bottom) Yellow Applicant •/
ADDRESS �(, ('DRESS,0 1 5 re" � 1` SC- Pr%(9(Le\ ,e t\ ^ / ZONING(office use)
V
LEGAL DESCRIPTION(office use only) V�2�/ /v
LOT BLOCK ADDITION
PID
OWNER q q �
(Name) A ✓A v7,,M
� �, ' (Phone) 6\ S U \� J 1``"`n
(Address) • VNJf,"-
(...at1 1--- St- p r,o r-- L4,,L(Q M4 ,Sj 3
BUILDER
(Company Name)
(Contact Name) .
(Phone)
(Address) (Phone)
TYPE OF WORK ❑New Construction
['Additionon [Deck ❑Porch ❑Re-Roofing ❑Re-Siding K'Lower Level Finish
❑Alteration ❑Utility Connection ❑Fireplace
CODE: ❑I.R.C. ❑I.B.C.
0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ —11 �0
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 revo .this ermit or just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
Signature I I— Ct- 1(19
Contractor's License No. Date
Permit Valuation
Z Q Q 0 _ (� Park Support Fee
Permit Fee # $
$ G Z. ZS" SAC
Plan Check Fee # $
$ Water Meter Size 5/8"; 1";
State Surcharge $ $
66 Pressure Reducer $
Penalty $
Sewer/Water Connection Fee # $
Plumbing Permit Fee $
_go Water Tower Fee # $
Mechanical Permit Fee $
Builder's Deposit $
Sewer&Water Permit Fee $
Other $
Gas Fireplace Permit Fee $
TOTAL DUE $ 75-
This
Application Becomes Your BuildingPermit When A //7
Approved Paid //7, 75"
I Date 1Re - .t0. (o/rpb�j
Building Otticial 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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued. proceeda as requested. This document
bet
a Certificate of Occupancy must
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
Residential Building Permit Checklist
Basement Finish or Interior A.Iteration to Single Family Homes
BY: ,//// Date: //• /0, / d
Building Permit ,T 70./63 PID:
Site address /6,075— Zoning;
Legal: L B
Subdivision:
Eaisting S trucrur.. YES o NO
CONFORMS TO ZONENG YES
ORDINANCE O
., YES NO
Is this an expansion of the existing footprint or
'oinking heig t'� Refer to Planning
r
Is the property located within the flood plain? Refer to Planning
I ✓ -
Does the alteration include any additional ldtche� ? I
--s• Refer to Planning
Does the proposed alteration include any outside
ent<ances other than patio doors? Refer to Piag
Is the proposed use of the ,Wished space or
Refer to Planning
alteration for anything other than a normal single
family home (office, g_rouu hor„e, day care, etc.)? ✓
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BLZLDING ?ERti IT FILE TO
yI.A.Ii/TAIN A RECORD OF THE REVIEW.
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /( o9 0//66711 `77.
NATURE OF WORK i--00/02., Gtr VEL
--
USE OF BUILDING ee7
PERMIT NO. / 0 , /035 DATE ISSUED 7/, (0.
CONTRACTOR ,577tP7SOA/ PHONE q13. ii 1-"O
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
Ofin."
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL IOC
PLUMBING
HEATING (if required)
.1E
ifiglirMalIaraat
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1
FINALS
BUILDING
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