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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE. .
AND UTILITY CONNECTION PERMIT
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S~ 0'-10'0
~. ~~. ~::y. I PERMIT NO. D7- ^ 2..51
) Yellow Apphco.. U
LEGAL DESCRIPTION (office use only)
I ZONlNG,__) I
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to l.JlA.i
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LOT
BLOCK
ADDITION
PID 25.28'1' ()'1~, 0
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(Phone)
DER
ompany Name)~~i ~e,..() p 6&;.I 6-AJ !if
ontaet Name} -fUJN 0 fLr( 1f:L.P
(Address) , 1rrJ-e
UMr I h~e} ~l,-'t.{)-'~
(Phone)
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TYPE OF WORK 0 New Construction DDeck OPorch ORe.R~~: ORe-Siding OLower Level FiDls:JJ 0 Fireplace
DAddition OAlteration OUtility Connection r.iSC. 5f1' tUtje (.UJJI~ ~a.c" 2.!.
. CODE: l~iI.R.c. OI.B.C. PROJECT COST/VALUE $(j}(.., ~
Type of ~on: I n ill IV V A B (excluding land)
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 5
. on wh' is to the best of my Icnowledge true and correct. I also certify that I am the owner ur authonzcd agcnt for the
xisting te a allaws and will proceed in accordance with submilled plans. I am aware that the building
~II o~ 0 wor a df[2.. may ent2.~ tt;~ to perform ;r: 2;~nDi
Contractor's License No. Date
Park Support Fee # $
Pennit Fee $ SAC # $
Plan Check Fee S Water Meter Size 5/8"; I"; $
State Surcharge $ Pressure Reducer $
Penalty S Sewer/Water Connection Fee # $
Plumbing Permit Fee S Water Tower Fee # $
Mechanical Permit Fee S Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee S TOTAL DUE ~ ;} ~~ () 7 $
i?S-~7
Dale
I Paid
Date
~~
Building Official
z-z..z....G;'l
q '1~/o7
I Receipt No.
By ~O
534 55"
This Application Becomes Your Building Permit When Approved
TIus is to certify that the request in the above application and accompanying documents is in accordance with the Ci~ Zoning Ordinance and may proceed as requestcd. This dllcumcnt
when signed by the City Planner constitutcs a temporary Certificate of Zoning compliance and aUows construction to commence. Before occupancy, a Cl'rtificate of Occupancy must be
issued
Planning Director
Dale Special Conditions. if any
24 hour notier for all inspections (9!12) 447-9850. fax (9!12) 447-424!1
16200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE
INSPECTION RECORD
1'I-"9() CD~,!:~ ~(4et
~ '--At'& ~ u,..s.E1rL f#1teG/f
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO. - 0 DATE ISSUED
CONTRACTOR O/t.K/l!Z1) ~;"'Ii) PHONE '1.1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
,__ J
FINALS
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOT.'~E
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