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<4 PRIO
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
(4:(A--- 5• TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r /� AND UTILITY CONNECTION PERMIT I 1 ' 1. I-3
LANES
1.white File PERMIT NO.
2. Pink City I ' 13 �j 7 O
(Please type or print and sign at bottom) 3.Yellow Applicant
ADDRESS Z t )
, 611 & UbPti2. ?at xi. . 1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION ND 025-- 46t-i- 6-59-c
OWNER
(Name) ? Thr' NM 11-- T O NJ _ (Phone) LII), 3 q 4- 3 Rz)
(Address) 9-1.071 t D U R. '- A-1-14 ' 1 7250e. L IL
BUILDER 0�
(Company Name Rciz1-4%bc //b4Q1 in.) k .WL-1111110.M., (Phone) '7lo 3 441' eel )
(Contact Name) ')S&r Y'AE(i, (Phone) 1i I X- bi 1p S- awla
(Address) At Sv Si1Al'-Il4 r2et-i.' 0,115, Out V.Actz , obJ 6755$
TYPE OF WORK 0 New Construction 5irDeck Porch :Me-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: [ .R.C. DI.B.C. 0 Misc.
Type of Crnstruct5ion I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $55-,63-2),
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-mention .p. 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 , oke tit' emit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
J000.-_.A11113,- .irtta 81.6Aci14I 1)-25-/5
Signature Contractor's License No. Date
Permit Valuation i -7/D 00„ Park Support Fee # $
Permit Fee $ 24‘4.1`; SAC # $
Plan Check Fee $ '1 k .5`I Water Meter Size 5/8"; 1"; $
State Surcharge $ $.50 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE 1j- ceso I (3 $ 414.8 4
This... i .on ; comes,Your Building Permit ved Paid ci ! r0 y Receipt No. '7 OF
/ t�� Date 7 3h By MJ
L� 'A — tz (
Buildin•Official Date
This is to certify that the equest',the above application and accompanying do ,ents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed. e C '' .,,er r.nstitutes a temporary Certificate of Zoning..mp.:,ce and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. 4
(L Z
Planning s r _b. Date
Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)4474245 ._
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 17 'G
NATURE OF WORK
USE OF BUILDING S � 2-
PERMIT NO. t 3. 133a DATE IS UED 1272/3
CONTRACTOR —. t352c-,n-,--4C .s ,��(c>.Ai PHONE Z. SGS-2o4Z
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSP TOR DATE
FOOTING 12/p
ThIlistaKaGlOgrior To Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
S ......ate=
FRAMING � �3
INSULATION !�`J
ELECTRICAL
Jaundiftle–
SE
GAS-EINE-MR TEST
-RADOWRETARDER
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
HOUSEWRAP 4tilt4A LATH
FINALS
PRIOR TO SODDING)
'BUILDING
ELECTRICAL
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