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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
52-c) ,o()
ADDRESS
n at bottom)
White
Pink
Yellow
File
City
Applicant
PERMIT NO. O~~ ' {J /0 /
..5 085- PtJ/I/ OJ cu c:6" L/l/
ZONING (office use)
~L
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ~ (){J4- /i 1(1, ()
OWNER
(Name) \~_ '- ~',-
~.~
~ ........,(;. ..... \,.., c'~ ".'" "
L\
'\,c", \..
(Phone) c.~ .;::::'=>-_ '---\\. \'-'" -~-'- ~ '-_\
,
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding
OAddition OAlteration OUtility Connection
ower Level Finish 0 Fireplace
;3 /Z~J.
CODE: E.R.C. OLB.C. o Misc,
Type of onstruction: 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 /V ALUE $
(excluding land)
I hereby certify that I haw hlrnished Information on this applicatIon which IS to the best of my knowledge true and correct. I also certlty that I am the owner Dr authollzed agent Illr the
abow-mcntlOned property and that all constructIOn w1l1 conform to all existIng state and local laws and will proceed m accordance with submltted plans. I am aware that the buildmg
official can revoke thIS permit for Just cause Furthermore, I hereby agree that the City official or a deSignee may enter upon the propeny to perform needed mspectwns
,,~ .=f-"-
r ';.. --~ ~
Signature
Contractor's License No.
.2.:..;.__ ~r:'-(, ~.
Date '6-~'-'('L
x
Permit Valuation 01 l/ {i ("l. l:J ()
Permit Fee $ -r 7'1. 75
Plan Check Fee $ -
State Surcharge $ /.50
Penalty $
Plumbing Permit Fee $ f() O(i
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace PermIt Fee $
This Application Becomes Your Building Permit When Approved
~':~ a/~(ofQ
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; ]"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other L-Ci; C...77e 4 c'..-?j i- $ I t' (J
TOTAL DUE $ //7 Z.5
Paid
Date
I/j! ~
3, - I. (J 6
;
Receipt No, 5//(:cl
B~~.
U'
ThiS tS to certlty that the request m the abow applicatIOn and accompanymg documents is m accordance wllh the City Zoning Ordinance and may proceed as requested TIllS document
when signed by the CIty PI,lnner constitutes a temporary Certificate of Zomng compltance and allows construetion to commence. Before occupancy, a Certlficale 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
]6200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUIL,DING AND INSPECTION
SITE ADDRESS 5lJf35 PCJ/t/OSc.;vC-re ?/J.
NATURE OF WORK L,()luDc t-6-V6~
USE OF BUILDING /{~ rr-//,-
PERMIT NO. 06 . () /0 I DATE ISSUED 3. Z Cl () b
CONTRACTOR ~A/ PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~~r } ~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
[
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
]
BU!LDING II- -(C1--vt,
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN
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