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tof pRlo� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
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I. White File
M�n'NES��P 2. Pink City PERMIT NO. (0- if
3 Yellow Applicant
(Please type or print and sign at bottom)
jADDRESSZONING(office use)
a% (80 , Si-ore.c,,e PA , Pm,,, L,,, ; MN -,S SI
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER c UDNAKAit �AP " (Phone) 5--a - I — 4,
(Name) V �' aa /
(Address) , �$0 > Tn J E CIaE T PATH , Ps to a. LAKE , N N 5. -311
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ['Deck ['Porch ORe-Roofing ORe-Siding Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: I.R.C. ❑I.B.C. 0 Misc.
Type of onstruction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI R 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 can revoke rhi,p rmi just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed mspec ions.
x • a8 lU
Signature Contractor's License No. ate
Permit Valuation 3 0p0 — Park Support Fee # $
Permit Fee $ .1196( � j SAC # $
Plan Check Fee $ �O Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $
Sewer/Water Connection Fee # $
Plumbing Permit Fee $ .a:.J_ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $ -
•
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee `$ TOTAL DUE $ I trp.Z S
This App n B Imes Your Building Permit When ppr t ed Paid I ` Receipt No. �
�
ei
t 0174/4 1 t AL
Datef
O By
Buildinw Otiirri Date
This is to cer• that , request in the above-application and accompanying duct, ents is' accordance with the City Zoning Ordinance and may proceed as requested. This document
when Signe. he'.1' Planner constitutes a temporary Certificate of Zoning c'.mplianc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. , 1 I
o
1irector
�/-\ / Pate 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 R I O R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 2 lad) Ss-T-4/%4r° cTzterST �-Pe-w(/4
NATURE OF WORK „" l5 14.. 1-0-10‘: Ldue-c-
USE OF BUILDING A fp__
PERMIT NO. to- 6 4, DATE ISSUED Z il o
CONTRACTOR a AA JA smveeNel PHONE ctS2- 2.-K9 •41z4
NOTE: THIS IS NOT A PERMIT OR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING LV Zcl
INSULATION /
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
411110111.1101,111111.1111.00
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