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0of P14/04 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
cn AND UTILITY CONNECTION PERMIT / W. /Z.
40/NEso'tt> 5L U /O,r0l�1
I. white File I
2. Pink City PERMIT NO./� i/�J_I
3 Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
4/4 5 Q4zi CL./12 .
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) - - - ice-, L" L (Phone)
(Address) -1/4'3 EjYa &4 '.,
BUILDER
(Company Name) _4' • .) C , ,
(Contact Name) _ C L (Phone) � S
(Phone) 4, k
(Address) ,04 J /DAJ° RLc AL)
TYPE OF WORK 0 New Construction ODeck ❑Porch ❑Re-Roofin
❑Addition Alteration ❑Utility Connection g ORe-Siding ❑Lower Level Finish 0 Fireplace
CODE: I.R.C. ❑I.B.C. 0 Misc.
Type of o struction: I II III IV V A B40, .
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ OM
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I ., c lrnished 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-mentione. . ope ., an. 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 - 6 k • per.' o just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
— i..•�'
,,.e!!!'','
+' ' reContractor's License No. Date
Permit Valuation41t�� Looe, ,e, Park Support Fee # $
Permit Fee $ t SAC # $
Plan Check Fee $ 19 Water Meter Size 5/8"; 1";
State Surcharge $ L . Pressure Reducer $
Penalty $
Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 5� y V Water Tower Fee # $
Mechanical Permit Fee $ 1J Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE e
mu) --iii i I ii..... $224'.4S—
Thisplic.tion co es Your Building Permit Whe Ap r ved Paid d - 3 - Receipt O. 6 J
• Date # jZ. By 4„7.1.-_-;
Bt 11Radril.11.111 Date
This is t ertify th' 't e request in the above application and accompanying d ument is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when si'..ed by th.f, y •anner consj�tutes a temporary Certificate of Zonin compli cc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued f
u
- •• 7 1 d ►Z--
Date Special Conditions,if any
24 hour notice for all insp ctions(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
PR 'OR
DEPARTMENT OF
BUILbING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 4 4-3 A,,
NATURE OF WORK
USE OF BUILDING �� t
PERMIT NO. Z DTE ISSU
CONTRACTOR - ^L. PHONE . -Z
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS
OW
THE PERMIT IS BY SEPARATE DOCUMENT S BELOW
INSPECTOR DATE
======I
Prior to Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
s:eavanammiSEPTIC 1111.1.11.11111111111111111111
FRAI SUILATG IN
�/Mk l'7/MI
ON
11111111.1.1111.111111111111111
ELECTRICAL
PLUMBING c 111111111111111111
s` ��� r',
rimammim
HEATING (if required) 1A)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
rior to Sodding)
BUILDING
ELECTRICAL
1111111111111.1
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