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oF re� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, �� � � ��, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � �—
�' � �� �' AND UTILITY CONNECTION PERMIT � � � � � ��
., �$ �: �
U �.
M��'NESD�P 1. White File PERMIT NO ,�} ��,. �O Y') y`
2. Pink City � � /
3 Yellow Applicant U
Please e or rint and si n at bottom)
ADDRESS ZONING (office use)
" � U � ' ' ' r ! � ��/1 sG/ �`� a� ! �/ - V �/ / �/ �'`" —"�'t�.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
��'� . � LJ�� D�28� ��� f12 ��'�'3
(Address) ��'�' / �- �j �
BUII.,DER
(Company Name) (Phone)
(Contact Name) (PMone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection 3 ��5.
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT CO$T/VALLTE $
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished i ion on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authoriud agent for the
above-menhoned prop that truction will confor to all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the building
oft'icial can revoke t' per f � st c e Furthermore agree at the city o�cial or a designee may enter upon the property to perform necded inspections.
X
Contractor's License No. �.`�; i:
Permit Valuation 3 � �O Q � Park Support Fee # $
Permit Fee $ � � 7S' SAC # $
Plan Check Fee $ — Water Meter Size 5/8"; 1"; $
State Surcharge $ ! . � Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ �r O � U Q Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ .SO , U U TOTAL DITE $/ �, Z
This Application Becomes Your Building Permit When Approved Paid �p, �i � t No.
Date .3 .1�.0 B
Buildina Otticial Date
Th�s �s ro certify that 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 consntutes a temporary Certificate of Zoning compliance and aliows construction to commence. Before occupancy, a Certificate uf Occupancy must be
1SSllfd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, Tax (952) 447-4245
4646 Dakota Street Prior Lake MN 55372
\ \
L� . aJ�F"e���3 ���VIENT OF
� BUIL�INC AND INSPECT N
�
I N . P . �'1 ,
� Q � f�
�G R D
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SITE ADDRESS _�I�� ��,�,5� /�/�.S.S
NATURE OF WORK
USE OF BUILDING �
PERMIT NO. DATE ISSUED
CONTRACTOR PHONE� O ,�
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT� , Q�,�..c��_��,��
iNSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING ./° I�
INSULATION � �,
ELECTRICAL �tj; L,
PLUMBING �f - � b I� t,�
HEATING (if re uired)
FIREPLACE �-! on/ C'l��.S�� • L z�,
GAS LINE AIR TEST ��" �'`' �`�'�+�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING � � ,
ELECTRICAL .
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS �EEN 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 t�uiidings and additlons
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9�50