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PA, k c CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
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t.. I. White File /Z ' /f'�% r
N,,''s' z. pint city PERMIT NO. L7 !I
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3 67c 're/7( I-4 i 1 ref ARA/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER(Name) gH ��;to i '1�- ( ) (q 2?./.„-L/7 0
'L^/ Phone
(Address) 36 ei se- 6C 7-4, / /'— , / /-1/1.--t/
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding Lower Level Finish 0 Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
•
Type of Construction: I II III IV V A BPROJECT COST/VALUE $
Occupancy Group: ABE F HI M R S U (excluding land)
Division: 1 2 3 4 5
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 pro.• 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 rev .''permit for just cam- - hermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
Signature Contractor's License No. Date
Permit Valuation 2-, 00 Q - 00 Park Support Fee # $
Permit Fee $ 6 2. z5_ SAC # $
Plan Check Fee $ ---- Water Meter Size 5/8"; 1"; $
State Surcharge $ / v Pressure Reducer $
Penalty
$ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ ..6•,. 6"7 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ 54. CO TOTAL DUE $ /72-, ZS
This Application Becomes Your Building Permit When Approved Paid )7Z..'7..5— Rec f.t No. br7 ((/
Date .i.,// iZ. :
if
Building Official Date
w 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 Prior Lake,MN 55372
01 PR/04) Date Rec'd
'", CITY OF PRIOR LAKE PLUMBING PERMIT
U NES
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,. Blue File PERMIT NO.
z. cola City3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
369C 1-/teli/ 7,-q1/ ,vvl/ Tr;C; , 1/17,✓ s3--3 7_
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER -�J(Name) !`—f 9✓� t�� ))�7 i`4 of „..7e, _ (Phone) &4.4" 691° — 9 70?
(Address) ..?b c-. 1:6-)( 7-;;/ 7- 7,/mo7 v W 7r40- 4 k/ fir✓ 33-3 ;vim
APPLICANT //
(Name) �yoi r7 (�/ Gay hL (Phone) &6? 2/a 70l
(Address) 3Z”--- rex. /0,-/ /rg;//l/Yl/ 77, - 1-o7/ii iiot/ 5-5-37,2.-
(Address)
7a(Address) (City) (Zip Code)
(Contact Person) 'S4" C c-$ 4l40-✓G- (Phone) J /2"0/t4 APPLICANT SIGNATURE ______> DATE / /
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater \'
Floor Drain Water Softener
/ Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
/ Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
/ Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential.New One&Two-Family $149.50
cR-eilaTritial,Additions&Alterations
Estimated Cost $ Building Permit# —
PLUMBING PERMIT FEE $ \
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildinu Official Date A
24 hour notice for all inspections(952)447-9850 ,\
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIOR LAKEDEPART
MENT OF
BUILDING
AND INSPECTION
S ECTION
INSPECTION RECORD
SITE ADDRESS 36, 95- / ( /c/ .
NATURE OF WORK Leh/E/ Z-&--1/67---
USE
YL__USE OF BUILDING J' 4-/I2.�
PERMIT NO. IZ , 41 'DATE ISSUED �-
_ 5l / Z_._
CONTRACTOR eJf/CO/A1� PHONE Q*. z. z.10. 416/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
011111111111111111111111MMINSO
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING ‘2'" 8(7 /11
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required) ; Jv 'l
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
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B a11LDING
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