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O* PR.04, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U
x AND UTILITY CONNECTION PERMIT
44NEsOlt• I. White File
2. Fink city PERMIT NO.1 Z _ 3 i _
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1({LJ M.0\ c ' %-c'
o 1,&‘Ncsz iw 55372-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNE((Name) „_'VQ Isi K''ll (Phone) (P (1.-211 3 5Q
Phone
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New ConstructionDeck ['Porch ❑Re-Roofing ['Re-Siding Lower Level Finish 0 Fireplace
['Addition ❑Alter to ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. El Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby ce ify 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-ment.ned property and that all construction wijI conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can yoke this permit for just cause. Furth,,rmore,I hereby agree that the city official or a designee may enter upon the property to perform needed in•pections.
X �
_,_,_ ,, ., _ ,..i x.1.1°`' ,�
1 ? _
Signature Contractor's License No. Date
Permit Valuation i 000. Park Support Fee # $
Permit Fee $ (41 27 SAC # $
Plan Check Fee $ j 5:1( Water Meter Size 5/8"; 1"; $
State Surcharge $ 3 `7E) Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 54,931 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $ f'
Sewer&Water Permit Fee $ Othe. $
Gas Fireplace Permit Fee $ TOTAL DUE $ C %
This A'w ication t om:. Your Building Permit n Ap roved Paid 375 ¶(o 405-006,7.....Receip405-006,7.....f� 'n�
Date �Z¢ (z By Ve-+.�k
Bul dine Official Date
This is t. ertify th, the request in the above application and accompanying document is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when s, ed,y t.e ity P nner.eanstitutcs a temporary Certificate of Zoni compli cc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
tssu y'
A. AAz.A/ I�
�i3Elt!!!#4• � _ • 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 R I O R LA K E DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS I<o Z 6'6 TA t+(k I'A Cr.
NATURE OF WORK L.Lv& F„s,s44, w oC•-•W•
USE OF BUILDING e-e S pc-in--
PERMIT
c-i2PERMIT NO. tz •3l G DATE ISSUED g/z4/12--
CONTRACTOR
Z4! 1zCONTRACTOR rleBgM,-u PHONE clz-zi , • 550o
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
,. Sant
for to Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING . `?/3///5-
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
• ER NO WORK UNTIL ABOVE HAS BEEN SIGNED
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