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�' �' CITY Or' PRIOR LAKE BUILDING PERMIT, Date Rec'd
,v-
CERTIFICATE OF ZONING COMPLIANCE
t=1 AND UTILITY CONNECTION PERMIT 7- z 5 . / Z
dre ES 67
A
i. Pink City PERMIT NO. / 7
2 Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5 5 5 3 H1511 fan) a . E
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
n COQ
(Name) .. 1/r.r''Woa-- Cr9 rr� .7y (Phone) 1SZ S 1 12►
(Address) 3550 L.a17-2 R ctok 1* 10 S-1-- ecui t SS I( 0
BUILDER �� 1 ��,/��
(Company Name) 'r$r C„w',V71' ' LLB--- (Phone) S" N1 G....
(Contact Name) ..leg-g A-1 ( 3-rJ (Phone) Co (2— 2'6 I /282
(Address) 6 i i L I 1'YterS O In PHA_ 5 •- Pt� .% ka. , m n SS '- a3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding wer Level Finish ❑ Fireplace
DAddition OAlteration ❑Utility Connection
CODE: ❑I.R.C. DI .0 0 Misc: AJ Ct, rn 1 41 4 1 uu--
! n eat . C loser- '
Type of Construction: I II III IV V A B
Occupancy Group: A B E F I I I MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that ave furnished information 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 -men . - d p / 61, : n 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 can I ke .. t . use Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
f � ' 20 (037-56 t-- q_t Z .
Signature Contractor's License No. Date
Permit Valuation 4/ UO 0 o 0 Park Support Fee # $
Permit Fee $ e7 - 13 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ z - U 0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 4 .j Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ / 43 7
This Application Becomes Your Building Permit When Approved Paid / 4-37J J ceipt No. (0,1 e___
Date /. -1 re J
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 S.E., Prior Lake, Minnesota 55372
YRI� Date Rec'd
A µ C ITY OF PRIOR LAKE PLUMBING PERMIT t 7 , / 1
1
IMYEs0 L Blue File
2. cold City PERMIT NO. 1 .007f'
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5 5 3 ///34 : - 7 1 Ct
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER G i"2/Z / fit �i r , ( 0. (Phone) 6 / - 7L 7- 0 K s 7
(Address) 3 S S G L- / e d ie t / L? w-/z) s 4, t. j_ s` S / v
J // U � 'L � / 7 /
(Name) fig jU e. / i. / /i)-•,6)')- <
(Phone) J i O S
(Address) /1 7 R /Z b' S /VoQ 74 .4 ' c° 1) / 7 - 5-z- 5- ° ---)
(Address) (City) (Zip Code)
J
(Contact Person) I "` 7 (S S e k\ (Phone) C c ? -2/ 9 K S- c
APPLICANT SIGNATURE' DATE 2 7-.)- )2
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
3 Bath Tub with or without shower / Rough -ins
/ Dishwasher / Water Heater
Floor Drain Water Softener
3 Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
/ Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
3 Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
_5 t% (o 6 cc. c-eJ
The Minnesota Statutes § 326B.148 Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ 1)41
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 S51,20-10 ,� ,t � , A /
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ u i- t
is , beginning July
1
This Application Becomes Your Building Permit When Approved Paid �' � Receipt No.
' •
( I,,,is' , _' �, '�i ^'' �'' Da ` By
Building Official Date ff 1 �t—
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE - B OF
ILDIING AND INSPECTION
IN PE TI N RECORD O
SITE ADDRESS S553 iiii4NpO /Air e
NATURE OF WORK i , a - -
USE OF BUILDING :. a A
PERMIT NO. ATE ISSUED •
CONTRACTOR - ,._ „„.11, �. AV1 7 PHONE 1 2. "t
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
11., IIIW.I t _
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
___ _
ir -_______________ Aiiii
FRAMING �. ���
INSULATION -=-
ELECTRICAL -
PLUMBING
HEATING (if required)
-- ________
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I I
FINALS
•
BUILDING 0' , /rz
i
ELECTRICAL 1
1
PLUMBING
1
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