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of PRio+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
g AND UTILITY CONNECTION PERMIT J
A'NE3o I. White File
2. Pink city 1 PERMIT NO. (4. I
(Please type orprint and signYellow Applicant �a
at bottom)
ADDRESS
t, ZONING(('offfice use)
�L'Lr\bNT A1/L NJ , `S�..v Y.Up , MN SS31,9 �(S1�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID 9c, ` -l7 ' O)Y.0
OWNER —
(Name) LW-kC- V ArN`Ji y KliV
(Phone) -1 S-ISL-Q.ogc.b
(Address) },'"t"a?j '3L1... o f\r7 aV C N W 1 S Ek1A\4-...oT , t•4/•-) 5 3-19
BUILDER
(Company Name) S ,`Z P
(Phone)
(Contact Name)
(Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding Lower Level Finish ❑Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: .C, ❑I.B.C. 0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 2-0.4-.`1
Division: 1 2 3 4 5 (excluding land)
II 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 c- revoke this permit for se. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
IX � . p
Contractor' —114
s ���r/'s License No. Date
Permit Valuation 4 O 0Park Support Fee ##
Permit Fee $ bl,Z 5' SAC
y $
Plan Check Fee $ Water Meter Size 5/S"-12;___ _ $
State Surcharge $ ' Pressure Reducer
$
Penalty $ Sewer/Water Connection Fee #
Plumbing Permit Fee $ IIP' Water Tower Fee # $
Mechanical Permit Fee $ ��
Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ .—. TOTAL DUE
This Appllion : t me Your Building Permit Whe Appr ed Paid pto. //3
i����� Date //„ Z(. /tf t1
Mil 'ng Official Date
This is to certify at the r ,uest in the above /
when signed b Cit ' anner;mstitotes a tempura y Cerrtificataccompanyingf Zoning oc mpl ars is and allows co construction to commencethe City Zoning .
Ordinance
and
y,a ed as requested. Tansmustb document
issued a Ccruficatc of Occupancy must be
I`''mo / / 1 -
, annin_ Date
Special Conditions,if any
4�4 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
4PRto
CITY OF PRIOR LAKE PLUMBING PERMIT Date Recd
iOt, t ( 7� rci
I.BlueoliI PERMIT I
2.Gold City NO. ,
(Please type or print and sign at bottom) 3.Yellow Applicant �Z
ADDRESS
11?).7 �t=.Ldorv� �,C N1/J V(JSDZO G(officeuse)
S -- . , -- -
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ()-S-' 14L(q ()aq.
OWNER _L-
(Name) IZ-t C V,gti► 1>
(Phone) 1lS -2SZ-(.00(.0'a
(Address) f g'3 -6t ..g- ar1'- iNve NW , S�}/�� G , M►J SS 3-162
APPLICANT
(Name) OW N'@CZ
(Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE DATE -17-I
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixtureuanti
Bath Tub with or without shower Q tY Type of Fixture
Dishwasher Rough-ins
Floor Drain Water Heater
Water Softener
Lavatory(Bathroom Sink)
Stand
Laundry Tray(1 or 2 compartment sink (Washing Machine)
Shower Stall Seewawagea Ejector
Sinks Backflow Assembly
Bar Sink Backflow Assembly Test
Water Closet(Toilet) Lawn Sprinkler
Other
FIndustrial,Commercial&Multi-family 1%of job cost with$49. 50 E DULE
minimum
Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended t $
The minimum surcharge for a Building Permit#
"fixed fee"permit is$5.00 PLUMBING PERMIT FEE $
STATE SURCHARGE $ "_! _ f Of
TOTAL PE' FEE $
(Office Use Only)
This Appl !ii'ecomes Your Building Perm Wh: Approved Paid lig °eceipt i�"
1111111
Id
.r I Daterill1111111
Bu din O c�� Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIOR LAKE RNT O
BUILDEPADINGTMEAND INF
SPECTION
INSPECTION RECORD
SITE ADDRESS + ;G�-.,►.1 / 2 .
NATURE OF WORK L , ,,., ,S;
USE OF BUILDING A (L
PERMIT NO. t f i z 1 , DATE ISSUED 1 (r 7I 4
CONTRACTOR Ela-kc- i; NI h �4�-�`' PHONE 1 +
INSTALL EROSION CONRTOL AN �
D MAINTAIN CLEAN STREETS AT ALL TIMES
rte•- INSPECTOR DATE
�Th
V
.-FetINDATIOP4Prior To Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING
_EIREF L E-
GAS LINE AIR TEST
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
• FINALS
TO SODDING)
BUILDING F-4 2y/4,
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