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CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
I~
OWNER
ADDRESS 156~~S- ~~\j\l\. Tt""
CONTR.
PERMIT NO.
3~~.WJ,
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULA nON
o FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
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I. "'Ibo~t;c. +~E. t-
10:00 A f"\
J2~oo PM
2CD \ ~~
'719 {J 11..0 <:,
~*
07 - OO'l(t
e-~~~~L,
I)l WORK SATISFACTORY, PROCEED
o CORRECT A 10 AND PROCEED
, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTI
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
A-w I "2-3003
Date Rec' d
l. 2.4 , 0 5
1. White
2. Pink
3. Yellow
File
City
Applicant
[ PERMIT NO'.Q8. OOZh I
ADDRESS
~LLI,v I(2A-fL
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
G~CJ ~t
/J1 A-l J1...J r .
~
(Phone)
fo)7~ hrl- O()j tj
LLtAJlilY mtJ 7!h Dt L
(Address)
BUILDER
(Company Name)--.N I\-~SE:... ff- MtC l+N0 let-\-{
(Contact Name) I, rY\ ~~l.
(Address) IlL 5. W~NI+A. ~---~ ~UIIC: tQl
(Phone)
(Phone)
(oS" J- '777 -ClClo I
(o~/- z: I.{(o - 1 ~2-t..t
TYPE OF WORK. 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddition DAlteration DUtilityConnection ~-e..r-t - fk.or~ Sprl'1I.XJ-U'
CODE: DI.R.c. DI.B.c. D Misc:
Type of Construction: I II ill IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
(hA I k.l
PROJECTCOST/VALUE $
(excluding land)
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 operty 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 revo this permit for just cause. FuI1he r, h eby agree that the city official or a designee may enter upon the property to perform needed inspections.
. ~ (J:in3"L 1- l:S-o i
Contractor's License No. Date
Permit Valuation Park Support Fee
Permit Fee $ SAC
Plan Check Fee $ Water Meter Size 5/8"; 1";
State Surcharge $ Pressure Reducer
Penalty $ SewerlWater Connection Fee
Plumbing Permit Fee $ Water Tower Fee
Mechanical Permit Fee $ Builder's Deposit
Sewer & Water Permit Fee $ Other
$ TOTAL DUE
Paid
Date
$
$
$
$
$
$
$
$
$
(~/,,01 ~;ei~0S5l.'9
#
#
#
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This is to certify th t 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, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372