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of PR/p� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
a f' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE -t—" Z7"/�
Ci xNI AND UTILITY CONNECTION PERMIT `�
40mEsoll' i. White File
2. Pink City PERMIT NO. /ii, °(
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRNZONING(office use)
gre-•‘hn9Iiii,, Q4/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNERcatyea„,, l,,
(Name) (Phone) 953- g.340'/ 7/4
(Address) ?O 91ec4 `�r e I Ii H Igli
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. LG1Wac— —z'�e 7 �'/"/
Type of Construction: I II III IV V A B fiMisc.
.
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
(excluding land)
Division: 1 2 3 4 5
I hereb certify that I have h•t informatio 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- ' i+ ed propsrty r all c s u�'on will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offici. oky this' rm aC r` t•,t, 1.-hermote,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X til. ' /
Signature Contractor's License No. Date
Permit Valuation 1� G1 0 0 _ o O Park Support Fee # $
Permit Fee $ 3 ?r SAC # $
Plan Check Fee $ _.r. Water Meter Size 5/8"; 1"; $
State Surcharge $ ` e5-0 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 54‘... St Water Tower Fee # $
Mechanical Permit Fee $ V Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 0 r{ 7,5
This Application Becomes Your Building Permit When Approved Paid 0J`, 7 S Re Ipt No. 7f, -15---
Date c. Z7- 4
Building Official Date
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
04 PR/0,4)
Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
Blue
con City PERMIT NO.
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
Az-f gre he)gMc LINLINf civ p}iDV1-th
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION Pu)
(ONaWNER AA, A ly ho. f (yP�^n/e)(Address) 39t1 / gird / -m)'/4 .t) i1/AV 7A
PPLICAN i / I / 1' 1,a 9`� `"�
(Name) ��j�J� C �J�� i,/ �(Phone)
(Address / ieh / Ty. l/If �12U)��L/it 7�
(Address V (City) (Zip Code)
(Contact Person) 1'á/g446 (Phone) (2e 4t?-N0-4064
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
1 / Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New On ° I V1014.10,200
Residential,Additio • .`„i, i
Estimated Cost $ Building Permit# 8VV{{The Minnesota Statutes§326B.148
PLUMBING PERMIT FEE $ "SURCHARGE"has been extended
STATE SURCHARGE $ The minimum surcharge for a
TOTAL PERMIT FEE $ "fixed fee"permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildine Official 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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 3 q 01- 67/-2.6-5 7%'t
NATURE OF WORK G��f t - �- f /-7
USE OF BUILDING
PERMIT NO.
l Y) DATE ISSUED Z -7. 4-
CONTRACTOR ,Sel e L... PHONE 9rz _r3@ (.0 7(
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
11111111111111111111111.
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
11111111111111
FRAMING = 1 Zt.&
INSULATION ,
ELECTRICAL
(
PLUMBING U4 Dom-
HEATING
11111ME
11111111111111111111111111
11.11111111111111111111111.
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH J 1 I
FINALS
BUILDING 3 I,
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