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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
4- Z3.07
White
Pink
3 Yellow
File
City
Applicant
I PERMIT NO. 01 0 zs ~
~C{d
0('
LEGAL DESCRIPTION (office use only)
LOT
PID z5. +
BLOCK
ADDITION
OWNER y\ _ ,"
(Name) ----t).f /ttJ 'Je('}~t-VV\.AN'
(Address) fL(/7
(Phone)
BUILDER
(Company Name)
(Contact Name)
(Address)
ZONING (office use)
. 048 . 0
(Phone)
(Phone)
~J-Z-YVQ-S /07
(0 ('z- 8'67- 3 Iq?
./-
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration o Utility ConnectlOn
ORe-Siding ~4=eR4~i~i~1 ~ pi~CPlacc
/};OU"
CODE: OI.R.C. OI.B.C. o Mise
Type of Constmction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
PROJECT COST/VALUE $
(excluding land)
I hereby certlly that I have hmllshed mtlJrmatHln on this apphcatlon whIch IS to the best of my knowledge true and coITect. I also certIfy that I am the owner or authorized agent tor the
.lbnve-mcntlOncd property and that all cllnstruction will conform to all eXlstmg state and lncallaws and will proceed in accordance with submlttcd plans. I am aware that the huildIng
()f!iClal can rev()k ' t till Just cause Furthermore, I hereby agree that the CIty ofticial or a desIgnee may enter upon the propel1y to perti)rm needed inspections
7a'~
/ Signature
"C..ctJ ~ S~ 7
Contractor's License No.
Permit Valuation
Park Support Fee
SAC
#
#
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee ."9===
Mechanical Permit Fee
2..00
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
+0.00
Water Tower Fee
Builder's Deposit
Other
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
TOTAL DUE
y- 2-.1-G '7
Date
$
$
$
$
$
$
$
$
$
ThIS IS lD certIfy that the request In the above apphcatlon and accompanYing documents IS In accordance with the Clly Zoning Ordinance and may proceed as requested TIllS document
when signed by the CIlY Planner ClInstltutes a tempmalY Certificate of Zoning ClImphance and allows constructIon to commence Befme occupancy, a Certlticate of Occupancy must be
isslIed
Planning Director
Dale
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS /~/7B {)RD~Ete.- CA'~
NATURE OF WORK '-0 w@L L-t:;-ve?-
USE OF BUILDING tee;- ,4/1<-
PERMIT NO. 07. 02.S2- DATE ISSUED <1-. Z3~ ()7
CONTRACTOR 7JfoM~so;J PHONE G,/Z. (/"7.3797
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
.
II
TIL ABOVE HAS BEEN SIGNED
OUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
-
-
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