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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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Pink
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File
City
Applicant
PERMITNO.O~ 0/&2-
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51a31 t'~
S,NE
LEGAL DESCRIPTION (office use only)
Sl'llv'o P~I A/I 57Jf
PID 25.231. 0/6.0
LOT /5 BLOCK I ADDITION
Date Rec' d
3./. {,IS"
ZONING (office use)
PLIO
OWNER -<? A
; ~f~. . XoP;er , C4~")OJ\J
(Address) -5!6~ C1dA~ S-r
w: 9SJ-1m-03t,g
CeLL q~-~c2-S39;{
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BUILDER
(Company Name) B~f^ Px'ILP/~SjI~1l?n1~
(Contact Name) -.-eARP> f.2Drrlee
(Address)S..:;9t7 2Z2 S~ Etl,sr-
(Phone) _@5j-430-3ff8&
(Phone)
ORe-Siding OLower Level Finish
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing
OAddition OAlteration OUtility Connection 0 Misc.
CODE: &1I.R.C. DI.B.c.
Type of f;;'nstmction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
PROJECT COST IV ALUE $
(excluding land)
ahed
o Fireplace
I hereby certify that 1 have fil ished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
above-menuoned p~~. d . t all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
:cial can rev ~ cause. Furt~. I hereby agree that the Clly official or a designee may enter upon the property to perform necde3n:;t:~S
./ '" - f~.~.;..;t (j Contractor's License No. i~'2q,'Q~ if
This Application Becomes Your Building Permit When Approved
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Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
"2,500. () 0
7-1- ~15
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
'1v.oO
ditJS";)-
j. l ~
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee #
Water Tower Fee #
Builder's Deposit
Other
TOTALDUE ~ 3.2-. DS"
, -
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
~ ~ 3/z/o.>
Planning Director ' r Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Paid
Date
zL,,~ -
-:I;;...~"05
Receipt No.
By fA
a
-4
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS ~ ~l/JfNtJfJD ST.
TYPE OF WORK A~s.ro~ ...s ,~en/K&
USE OF BUILDING ~ A/A!.
PERMIT NO. 1J5. IJ.LJIZ. DATE ISSUED 3. z. ~S-
BUILDER ()L$f)P PHONE # HZ. IJ>>e
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I I J
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
J FRAMING I I
~ FINAL
j'lii
/ I
.j/6/()-~
FOR ALL INSPECTIONS (952) 447-9850
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,zJ--PtNAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
, _~z:;r
COMMENTS:
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TIME
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
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.hORK SATISFACTORY , t'l'{v('E~D
/ 0 'cORRECT ACTION AND PROCEED
o CORRECT WORK/.C~~EINSPECTION BEFORE COVERING
Inspector: ~./ Owner/Contr:
~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!