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f PRIp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 14 0
AND UTILITY CONNECTION PERMIT
MiA'NES____ I. White File PERMIT NO
3 Pink City Pin 0S • ��
3 Yellow Applicant (� 66((//66
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/-ice 9e XI/a/5 fry/ Am/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ���f �
(Name) c ri (Phone) (Phone 743— fa ly , (,t2c5
(Address) CSalm.e.)
BUILDER *Adam) h i b ok etAildtry '
(Company Name) (Phone) q
(Contact Name) 1 • - O - 4 A. (Phone) 912- � J�O Bd 9
(Address) AI3 ie'L K , F N� Pno r ' 4.-- I
TYPE OF WORK ❑ New Construction
❑Deck ['Porch ❑Re- Roofing ❑Re- Siding yif,ower Level Finish 111 Fireplace
['Addition ['Alteration ['Utility Connection ,, �LL
CODE: ❑I.R.C. I.B.C. ❑ ❑ Misc. (4- rOcle- on ly)
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ a4 cc • o>:"
Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5 (excluding land)
1 hereby certify that I have furnished infor. ation on application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above - mentioned prof and that all .estructio wil conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
•
official can re 1 e this .ermit for just .,,i se Furt er ..re, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
II
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Signature Contractor's License No. Date
Permit Valuation 4 00 0 60 ' Park Support Fee # $
• Permit Fee $ 87 Z 5.- SAC # $
Plan Check Fee $ — Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Z • 0 0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee gY Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $� Other $
Gas Fireplace Permit Fee p TOTAL DUE $ 0q, 25
This Application Becomes Your Building Permit When Approved Paid e -I. zi� eceipt No. 5Z 97
Date /4-7
Building Official Date
This is to 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 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 Prior Lake, MN 55372
P R O
R LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS / 1` * f wR --e v'/evi
NATURE OF WORK G owl-
USE OF BUILDING /6/
PERMIT NO. Dr, 6 9 Z4' DATE ISSUED 1/.
CONTRACTOR / (Af/' -e PHONE 9S2 _ zfo b':16
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 I
hiliNINIMMONB ackfi
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING g•"4- /// !°A
INSULATION --
ELECTRICAL
MOM
HEATING (if required) /, /co
wow
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING — 471)2--
ELECTRICAL
rl
HEATING K)4 4
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