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of PRio+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
7 ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE e.. AND UTILITY CONNECTION PERMIT
~NHatEsolR I. white File PERMIT NO.
2. Pink City `2 853
3 Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
( 9419 9 . "s1tA Ne U i 12cc g_,/s.0
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID 5-'.- O 5 • 006 - O
OWNe 1'�C df\ 7 /2---/VI IM->°2/V( A Phone S2O(I`I ) (Phone) Co 12- �C' 'S
(Address)
l BUILDER '
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Cons ction ❑Deck ❑Porch ORe-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑AdditionJAlteration ❑Utility Connection
CODE: R.C. ❑I.B.C. �� ,Mise. e /ate e, �� �6
/As
Type of onstruction: I II III IV V A B T T/VALUE
Occupancy Group: ABE F HI MR SU PROJEC COS $
(excluding land)
Division: 1 2 3 4 5 1
I hereb i that I ave fumis • 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
ab -mentioned pr•.erty and t•at all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware at the building
ifficial can revoke is permit f• ju t cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins ect s.
r 26(
Signature Contractor's License No. Date
Permit Valuation 2 OCC .- Park Support Fee # $
Permit Fee $ /Z �; SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
i p
State Surcharge $ l Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ c-4-.5-0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE Cly a i i(3 $ !i / -u 7�
This • i li tion Becomes Your Building Permit en :pproved Cp,',41 T1 c. C Recei s t No. / -1
ATI i ........._ 4 7 r Date By S
400
• •, Date
This is t ertify teat the request in the above application and accompany g d uments is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sit by fie City Planner cq stitutes a temporary Certificate of Z ping ompliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued f
'V Z f S
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
O� PR104 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT 6 ,w• /
v
.Blue File '3 �j 3
.oo,d City PERMIT NO. / /J1 [�J(
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/5VM
END Jk PI,c) / /-5/3
LEGAL DESCRIPTION(office use only) ��yy
LOT BLOCK ADDITIONt PII) 0767 O --L(2 .0
P(Name) o D N G N( �--Z/VI NJ (Phone) Z g O 3 s20 62
(Address) L 5(69 ( .51 &,-N U `eL-(.) {2cJ
APPLICANT
(Name) 54/4Y714(5 (Phone)
(Address) 5—53 7 se___
(Address) (City) (Zip Code)
(Contact Person) ailligr (Phone)
APPLICANT SIGNA •' •' ' v ti 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
3 Lavatory(Bathroom Sink) / Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
I Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
2, 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
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit# The Minnesota Statutes§326B.148
"SURCHARGE"has been extended
PLUMBING PERMIT FEE $ The minimum surcharge for a
STATE SURCHARGE $ • "fixed fee"permit is$5.00
TOTAL PERMIT FEE $
(Office Use Only)
r ^^ ^
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
PAID WITH
24 hour notice for all inspections(952)447-9850,fax(952)WILD 1NG PFRM IT
4646 Dakota Street S.E.,Prior Lake,Minnesota 553
P R 'OR
LAKEDEPARTMENT
TMENT OF
BUILDING
AND
INSPECTION
INSPECTION
RECORD
SITE ADDRESS /564,f /SzA /1z VIEgi .
NATURE OF WORK Mir: Atm"
USE OF BUILDIN ,?/.IS
PERMIT NO. DA E ISSUED 8. '. /3
CONTRACTOR NNE/tit/44y y PHONE (i a. X 0 3. 5Z04
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I I
PLACE NO CONCiETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING *fr
INSULATION �/ I
ELECTRICAL
PLUMBING US ' -'.• y
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING DOJ 3/q/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