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o f PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE G
v t2,
AND UTILITY CONNECTION PERMIT e - to / iv
MikNES.�P I. white File PERMIT NO . 9,& 3 Pink City /� 3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS / #2'#& /9/9/17/C / , Z /� ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) icnc, i r / (� 1 I U )L (Phone) �— Ll ` 1 61 1 eS
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
❑Addition EAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished informal': 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- m•ntn ed property and that all construct': will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c., rr .ke this permit for jystrktse. Fur ore, I hereby agree that the city official or a designee may enter upon the property to perform needed ins ctions.
X All. Al 4._14 I. It /i
Signature Contractor's License No. Date
Permit Valuation 3 000 , 00 Park Support Fee # $
Permit Fee $ I 7¢. 7 5- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ j 0 0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fe (pid�i/� 1 �/Izi� J 50 Water Tower Fee # $
Mechanical Permit ee Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ .... ■ TOTAL DUE $ /34- 06'
This Application Becomes Your Building Permit When Approved Paid /, 0-6
i $ eipt No. /'
Date 0,/8 l c/ X •
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
Residential Building Permit Checklist .
Basement Finish or Interior Alteration to Single Family Homes "
BY: ir Date:
i b , r 6
Building Permit T : / 6 , & y6, PID: Zoning:
Site Address /1-2_4--6 p, &c V /6fr / G 'J6
Legal: L B Subdivision:
Existing Structure: YES or NO LomNcE - YES NO
1 YES NO
Is this an expansion of the existing footprint or Refer to Plarr+rig
building heig t?
Is the property located within the good plain? Refer to Planning
Does the alteration include any addironal l Refer. to Planning ✓
Does the proposed alteration include any outside Refer to Plannhag ✓
entrances other than patio door?
Is the proposed use of the wished space or Refer to Planning ✓
alteration for anything other than a aornal single
fa.=ily home (office, Traub acme, day cart, etc.)?
THIS CHECKLIST 'LUST BE COtCIPLETED . YD INCLUDED IN THE BUILDING ?ERIN= FILE TO
LEADfTAIN A RECORD OF THE REVIEW.
D
P R I R LA K E DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /424¢6 P9R& YieW
NATURE OF WORK 10 G8iYi
USE OF BUILDING . a I IY.
PERMIT NO. ow�rl DATE ISSUED %NE41C'
CONTRACTOR 'l`yA . PHONE :► _
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1UMW � .
1 . 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING , 17/Z 4
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1
FINALS
BUILDING 7/00
IJ
ELECTRICAL
PLUMBING
HEATING
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