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ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZOf'J~NG COMPLIANCE
AND UTILITY CONNEGTION PERMIT
I. White File
2. Pink City
3. Ye\low Applicant
/{P 04-5
frlPu.,~ Wfll./
LEGAL DESCRIPTION (office use only)
LOTe BLOCK 2- ADDITION ~/JJr1t- K../O(Y6 ?-A/.O
OWNER I
(Name) PJN ~ r ~/..J
(Address)
1kJ.r!
Date Rec' d
tJr-/5' U?-
PERMIT NO. OZ--/OOO
ZONING (office use)
PID 25- -!()2- (Jl1--0
(Phone) d-d.' - ~ 511 t/
BUILDER I .
(Name):f) r Q..:........./)... ef. ,AI (;.
(Contact Name) ~ V-IFY
- ,
(Address) /5 ~ 'J 9 Fn I r 11 4.# /'( 5 -rr /IJ e
TYPE OF WORK
. 0 Misc.
o New Construction
DLower Level Finish
(Phone) ~/-7.t;x--":1
(Phone) Ib I;) - t;. ff 5 - -;:S-/ ~ I
/JrlC>'LAK~
, -
o Deck
~-Roofing
DAlteration
o Porch
o Fireplace
DAddition
~Re-Siding Op~
SIO~ OA.'LV
DUtility Connection -,
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 p~pertv to perform needed inspecti7'
X ;:;--...-...-"? _~ ,~ ./ ~ 0 ~":1,j,~ 3 :3 ---.$ - J, C) - o;J-
~ Signature - ........- Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
PROJECTCOST/VALUE (excluding land) $
2/ SOV. crv
$ 74- 1 [-
$
$ /. 'l,...r
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
tbA'-J- g--l \ ....dL--
Building Official
Date
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
I Paid
I Date
7(;.(;) v
8"~>O -z.---
#
#
#
#
$
$
$
$
$
$
$
$
$ 7~.(/tJ
Rece~o. ~-z~1
BYfPV
()
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, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
DATE nilE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
~Jf{
~. ~ ,
OWNER
!(.(J.{ " v1Ac,( Lc uJ(
CONTR.
ADDRESS
PHONE NO.
PERMIT NO.
:2.- (000
[] FOOTING
o FOUNDATION
[] FRAMING
[] INSULATION
[] FINAL
[] SITE INSPECTION
COMMENTS:
[] PLUMBING RI
o MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
[] MECH FINAL
r~-roof c:./. ~lJc
[] EXIGRADIFILLlNG
o COMPLAINT
[] FIREPLACE RI
o FIREPLACE FINAL
[] GASLlNE AIR TST
o
~
fJ) T ,,-/ I1tAcl c.a vi k... O/Olfi1ci COM~v.s f~ ~l-7 ql-r
I {'tJ7/ p,\ ~ lclc:-.-
l.r,ovt t (}/L ...............
---.----;;-~ "\
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~---- --------
,fWORK SATISFACTORY, PROCEED
"'CORRECT ACTION AND PROCEED
[] CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: r1;f s-), q-O ') Owner/Contr:
QAtl" 447-9851) FOR, THr: Nr:.X:T IN~PECTlON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IlIS1IOn