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of PRj CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
3 Y P ell
ow TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
i AND UTILITY CONNECTION PERMIT
U
AIjNNES�•(!` I. White File PERMIT NO . -
Pink
ll ow A p C p y plicant _ 11 • ` .7 e9 / VV 1
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(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
32 ge fir 'i S SPri
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER l „
(Name) U I V ONflel (Phone) G G-- ' ' 0257.c
(Address) 32- l G r• 5 1 f Si/ ' v.. L c 14L
1
B Company Name) K-W0 Cos 4---.. }""
(C(P f 7�^ 42S 1
(Company (Phone)
(Contact Name) — l i ""‘ 1(1 'n (Phone)
(Address) 112 0 . J �„S . . l Aar_ 1--.."- Qv c 0 Al 41 vJ 3 S'__
TYPE OF WORK ❑ New Construction ['Deck ['Porch ['Re-Roofing ❑Re- Siding 'Lower Level Finish ❑ Fireplace
DAddition ['Alteration ['Utility Connection •
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ 30 000. U
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 information on this 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 -men ed property 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 re oke this permit for ust ause Furt hermore, I hereby agree that the city official or a designee may enter upon the property to perform needed Inspections.
X 02 0O3`42. 07 V 5/o)-ct / I
Signatur Contractor's License No Date
Permit Valuation Park Support Fee # $
Permit Fee $ 71 : 7 5- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 5. 00 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Firepla - Permit Fee $ Sqq. 5-6 TOTAL DUE $// , C-
T • Appli io �/ e ■ es Your Building Permit When Approved Paid Receipt p4 Ce 31g F
I Date By j //
i - 7 IS1 if
!Vding 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
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Smoke detectors shall be upgraded
as per the requirements of the IRC
CITY" F PRIOR LAKE throughout the luyise,. Battery operated
*noke detectors fray be installed in
'1 ERNT pLAN REviEw existing structures.
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Separate permits are reqtureo
TED-CORRECT for Pluir,
all applic , Heating
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Witt able builds, vg & zoning Gods 0 Outside Sevier and Water,
Kw WS PLAN SET ON SITE AT AIL TIMES. Electrical, etc.
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07/13/2011 12:04 9524926806 GLOWING HEARTH: /HIGH PAGE 01/01
4 r CITY OF PRIOR LAKE Date Recd
i.. k
HEATING/AIR CONDITIONING/ FIREPLACE PERMIT
Z1 ' All
4 i' 1t1Ese I. Pink Pk
:. caw PERMIT NO.
(Please bm espies and ai at bottom)
1. Y`M""" hPr'�a
ADD
3 e a (� If" f ' + S S+ ' ZONING
(otacr,�xe}
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LEGAL DESCRIPTION (office use only)
LOT BLOCK �ADDITTON PID
tii r�er
(NT ati l ,e_ ( . l L_1 /--fry
(Address) 61a tOCc .e
.APPLICANT
(Naa�ae) 7 `( a `{ ' (PhoAC) t)IS-- I a 'r' 9? 1 417
(Addrets) 1 0 o . a • � • eTojcaxg
(Address) (c' 5') (Zip Code)
(Contact Person) J t _ r I one) ali.r t{ C .,..„,„\,....=9 . 1. „-_
APPLICANT SIGNATURE _ _ 11 1 „i/ R ATE
• +'+ ANT PLEASE COMPLETE BELOW
°NEW CONSTRUCT
ONSTRUCTION - CI REPLACEMENT p ALTERATIONS
FURNACE MAKE AND MODEL _ FUEL
FLUB SIDE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWonn Air Plants p Steam Units and Fireplaces Cannot Encroach
0Oravity Hot Water
❑ Mechanical Radiation into Required we Yard Setbacks.
°Air Conditioning Special Devices Fireplaces with Box Additions or
°Vent. System (] per Devices Cantilevers to the Outside of Buildings
/
_+ � llt egnire a Building Penult.
FIREPLACE MAKE AND MODEL 1_ A j 4 t~.Lf �
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $4
$49.50 minimum
Residential, Heating & MC (New Construction) 5149.5(1 Residential, Additions & Attenadoas $49.50
Residential, Heating Only (Now Constrtmtion) $64,50 Residential, AC Only $49.50
Estimated Cost $ Building Permit # (6`
HEATING PERMIT FEE $ �' • ,
STATE SURCHARGE $ 5 ("D -- VI
TOTAL PEWIT FEE $ 5 4 -1-A_ S42_ e j 6 ---
(pence Use Only)
This Application 13econses Your Building Permit When Approved Paid Receipt No.
Date
s . By D WITH
�ai.g Official - -- Date 1J
24 hour notice for a1i inspections (952)447.9850, fax (952) 447.4245 BUILDING PERMIT
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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