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pi YK/043 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
t..,4`( :: TEMPORARY CERTIFICATE OF ZONING COMPLIANCEZ�� �Z
AND UTILITY CONNECTION PERMIT /�
-ler*NES° F/C/Ew///• 072-(O
1.White File
2. Pink city PERMIT NO.
/Z 73
3.Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS t I-1'7-3 3 0 i P if SI c t= C%�
LEGAL DESCRIPTION(office use only)
LOT 0-BLOCK k ADDITION i C-ec-EP-5 1/\)-1''�=1 R o'er-r PID
OWNER
(Name) 1. I'T 1 NI-s ' -1-4 U t`-1 i S (Phone)
(Address)'1 Z.a 1 t/-/A S H-1 tom,i t,t`t A v E S STE. 2_c. l G0 t tit-As Ntsd SSL1,39
BUILDER
(Company Name) 1-1 1\-- )'`tet i -+C't``ES (Phone)
(Contact Name) S v 8 (Phone)
(Address) 1'--C) I t,>' !c S 4 t+....1 C VO J N vE-S S"1 E- 2_v t >=-O t t.i.nc- M l,\ 4D ))
TYPE OF WORK , New Construction _;Deck ❑Porch ORe-Roofing ORe-Siding Aower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection .3 f2dv7
CODE: ❑I.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II III IV V A BG
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 9, b 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 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.
XC.
..�.-1 t::: BG. 2.A 7"1 S32 6 1 125 20 t '2—
Signature
Signature
Contractor's License No. Date
Permit Valuation 3 r 0 O C)0 Park Support Fee # $
Permit Fee $ ,7 4, 75 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ /. 5 Q Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 3-4-„5Z) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ _ TOTAL DUE $ /36, j
GG7
This Application Becomes Your Building Permit When Approved Paid ., 7 5 Recei No. k.5f V
Date / /...}-11, (, By
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 LAKE ' DROF
BUILEPADING TMENT AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /4-330 PAieir-‘510 E 6 •
NATURE OF WORK LdWEf2. L-61/67.--
USE
-6^YELUSE OF BUILDING /mss #1//z-
PERMIT NO. /2- 73 PATE ISSUED /• 2-4--
CONTRACTOR
`1'-CONTRACTOR A77 1`7 /fOC7 Es PHONE
NOTE: THIS IS NOT A PERMIt FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
11.1.11111
l
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
M
ilF /7I
!
INSULATIONELECTRICAL
G i2 t (7
(if
HEATING
required) !-'' l4 �2 f' -
C
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
IMOMMimmembil
.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