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o f PR�O� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � � ��
.. AND UTILITY CONNECTION PERMIT
U lrj
�►&NESOgP I. White File PERMIT NO. / �sJ
2. Pink City cY 4 `7
3 Yellow Applicant T
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1'1105 1°. -x.1--&-- PoTN.) 1 ck 56---
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER �"' ,�leA)E('
(Name) P.C/ i (•t (Phone)
(Address) l 1-/e1.07 P7x' pc5TAJT ce 5c
ComER i,irLmE5 COit)5 UCTI°' 5.2
(Phone) 47 -35-6--22q`
(Company P y Y Name)
(Contact Name) rJI'Y] W T L C"_) (Phone)
(Address) 732 3 ?Lm ST B FCC C !Li- N :-- h-u) .5-6,0i 1
TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection n p �,f Q
CODE: ❑I.R.C. ❑I.B.C. ID Misc. DtITl Rocin 3a) L-sva._
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ -.2C/00'0 •
Occupancy Group: ABE F HI MR SU (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 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 can revoke this permit for just cause Furthermore,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. dap
Permit Valuation 341 77' Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ C-0 Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 5,4 ST) Water Tower Fee # $
Mechanical Permit Fee $ 7 Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 0 9
This Application Becomes Your Building Permit When Approved Paid 0% I,S� Rec t No. cliggViR
Date 7 3 o ./(-/ By _ /
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
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /19a P/3L/� P Cea/C-
NATURE OF WORK ej2-riz4/6/�l
USE OF BUILDING 46S. //P
PERMIT NO. `� -7 7 DATE ISSUED �r
CONTRACTOR /(J,w/ ' et /,�J` PHONE QS-Z. 304, 226
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
MOW
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING /)o/1C
INSULATION .#04-0.
ELECTRICAL
PLUMBING ate--- 8)1+
HEATING
. . -_ - -
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
FINALS
BUILDING ,L.c._. �� l
. 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