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CITY OF PRIOR LAKE BUILDING PERMIT, ~z3 '1
TEMPORARY CERuJ4ICATE OF WNING COMPLIANCE.
AND tJ oLITY CONNE\., nON PERMIT
Date Rec' d
5.13.05"'
~. =. ~~ I PERMIT NO. Os, 04'Z7
l Yellow Applic:o..
(Please tvl'e 01' 1JIint and sip at [, . .,.,.,)
AvvaESS ZONING (offict' use)
ttDi'\ t ~ 1 \\ \C\\I\ l1\ 8J /!-/sO
LOT
BLOCK
LEGAL .LI'J:'.'~,-&'U..t .a: ':U'l'~ (otllce ure o11ly)
ADDITION
=: K-t{lJ \Y\ ~ Co. (Ol MlJgJ~
(Address) U nl1)- L J ,\ \ fMJ LV\ <6W
~~;:;Name) CJ\ '(luJ \(\(} ~ V t2:D ~ Illin
(Contact Name) fvt~1 (\ '.
(Address)~5lt u Cu eo{ ()
(Phone)
(Phone)
(phone)
PID 25. Z+/. (JC;c,. 0
q5d-. -~ l\ [) . ~ '(31
<.t6\ L{ Xl~ q ~~~
L 5\ =\'3{ 0 lq, 9BK
TYPE.QF WOBK 0 New Construction []Deck Dporch ~-RooJing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration DUtility Conne~ 0 Misc.
CODE: OI.R.C. DI.B.c.
Type of CoDStl'lKtion: I n ill IV V A B
Ocaapaocy Group: A B E F H I M R 5 U
Diyision: I 2 3 4 5
Plt();JECT COST/V AUJE S q f.t)Cf.} ....
(excluding land)
I hereby certify that Ilmve f_...~LJ inL",,,,..:,,,, on lhis appIicationwbiehis lOt:,. (.,'" of my ImowledJelnlt'amI~. I alsuemilYtbat I _1hr ._...aut~",,,,,J apntlOr!tll!
above-mentioned r'-r"'Y and that aU cOllStnlClion will conform to aU existilll state and local laws and will r' ..,..J in accordan~ witb submitted plans. I am aware that the building
:cial cmpffi;:~)sMcrmore. I hereby agree that thea~ officW Oir~ ;;ert~n the r,ur-"; to perform ncro57r~o)
Signature Contractor's Licenre No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
State Surcharge
Penaity
Plumbing Permit Fee
Mechanical Permit Fee
Sewer 8t Water Permit Fee
Gas Fireplace Permit Fee
2,500_ 00
I Park Support Fee
I SAC
Water Meter SizeS/8"; I";
Pressure Reducer
Sewer/Wl\ter Connection.Fee
s
s
s
s
s
s
s
s
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
I Paid
I Date
'1&.00
5./J()5
TIUs Application Becomes Your BuiI.inI Permit When A,. .. ..j
Buildina.OtTJcia1
Date
#
#
#
#
$
S
S
S
S
S
$
S
S ~(P.(jO
Receipt No. . 4-9/9~
By~
ThIS IS to certifY tbatlhc request in the above application and a'_.'''r..nying documents is in accordance with the City Zonin. Ordinance and may proceed as requc.'lltc.'<I. This document
when signed by the City Planner constitutes a........,.. _ J Certificate of'Zoning compliance ami aUows __...~.ction to .. _....,... ... Before ~"-r."'J' a Ct."l'tificatl: ofO___r_.:y must be
issued
PIamllng IL . ... .
Date Special COltcIitions. if lilY
%4 hour notice lor .11 inspections (9!l2) 447-9858, In (9!12) 447-42045
16200 Eagle Creek Avenue Prior Lake, MN 55372
DATE TIM&;
tb/Y~5 -
/ /
U/r;~Lc/ k
C\TY OF PR\OR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/67/7
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.A1=rNAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~ MECH FINAL ()
/~e /00 -f-!-
COMMENTS:
dF- Y,2.7
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~RK' C L F REINSPECTION BEFORE COVERING
/
Inspector: . Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!