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I 6
(Please
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
j. '7 0 1
] White
Pink
Yellow
File
City
Applicant
PERMIT NO'{l 7 () 0 Z-IP
324-4- sP~t/ee ~/'- sw
ZONING (office use)
JeISD
LEGAL DESCRIPTION (office use only)
LOT 1/ BLOCK 4- ADDITION SVIVS er HI (,..,t..S
PID z.s: 172.. 0(, I. 0
OWNER
(Name)
7b5 -, 522- OL\\.\.q
O,-;q~(// ye VCj€N / V
(Address)
".
V~OII'1
(Phone)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration OUtility Connection
CODE: DI.R.C. DI.B.c.
Type of Constmction:
Occupancy Group: A B
Division:
o Mise.
ORe-Siding ~Lower Level Finish
f-- eAJ5.
o Fireplace
I
E
II
F
I
III IV V
HIM
2 3 4
A
R
5
B
S
PROJECT COST /V ALUE
(excluding land)
$
U
I hereby certify that I have hlrnlShed mtlJrmatlOn 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 eXlstmg state and local laws and will proceed in accordance with submllted plans. I am aware that the buildmg
ot1icial can revoke this permit for Just caus > urthcrmore, I hereby agree that the CIty official or a deSignee may enter upon the property to perform needed InspectIons
x
Signature
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
~h 000. 00
$ 87. z..S
$
Contractor's License No.
Park Support Fee
SAC
#
#
2.00
Water Meter Size 5/8"; I";
Pressure Reducer
$
$
$
$
I $
$
Sewer/Water Connection Fee #
+0.00
Water Tower Fee #
Builder's Deposit
Other
b-z,.~ffl" '- ....
TOTAL DUE
This Application Becomes Your Building Permit When Approved
BuilUII1!! Official
Paid
Date
Dale
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 TillS document
when signed by the CIty Planner constItutes a temporalY Certificate of ZonIng compliance and allows constructIon to commence Before occupancy, a Certl/icate of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE
INSPECTION RECORD
~ "' 71/IH/'-
DEPARTMeNT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO.
CONTRACTOR PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
,
~ I
~I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
,--.-- ~
-- ~ --~- --
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
-
t
--------
BUILDING
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
..