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o f PR /0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4"/NNES011" 2. . white File Pink City PERMIT NO 7 r
3 Yellow Applicant .�
(Please type or print and sign at bottom)
-' ADDRESS ZONING (office use)
/ _ 3'' 7 4/,f9--/ cz.'i : Al. At
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (J 3 / "L' e=<< T' A5 •'`At / 6.?;, ), (Phone) 9.6 2 . •5 6 7 / 7
(Address) /''3 ,7 7 !�f'° 7 . ,C. e %/ /t/ Di/,
BUILDER
(Company Name) ✓ r (Phone) fr' /2, ,3 '7 ? /`
(Contact Name) /7//e-e" /- ..%'i'' e/L (Phone) Y- ? , 45 2 ,7 : v
(Address) /4 U � !, z:" /Y ' *f z, ,s/F/ .,1 ,t /,";,v ,S:j.3
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe- Roofing ORe- Siding Lower Level Finish O Fireplace
DAddition DAlteration DUtility Connection
CODE: JLR.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST /VAALUE S i Z, al:") Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5 l
I hereby certify that I have fitmished 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 - mentioned 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 can revoke this permit for just cause Furthermore, _ /
official I hereby agree that the city ocial or a designee may enter upon the property to perform needed inspections -
Signature • Contractor's License No. gate
Permit Valuation '3 0 -- Park Support Fee # $
Permit Fee $ .( SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 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 Fireplace Permit Fee $ TOTAL DUE $ ( \ w - --
1
This icat j■ n ecomes Your Buii�ing Permit en AQpr v
ed p; , - - �11 ��i E Recei a t N.. gam
• r Date By IFi
Bu nsOftrcial Date
This is to ertify that t . request in the above application and accompanying doc ents is accordance with the City Zoning Ordinance and may proceed as requested. This document
when si+y1fi by t , C' i Planiter constitutes a temporary Certificate of Zoning c . mplianc'' and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued f J
r' T anning Direct. 1 at Special Conditions, if any
z .. r notice for all inspe tions (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS j 4 ' 7 ( A..cal.i
NATURE OF WORK r3 t5 vk Gct.1,�., 2
USE OF BUILDING =
PERMIT NO. 1 -7: DATE ISSUED
CONTRACTOR t\ L - PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1
(Prior to Backfill) 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
-S
FRAMING 7.23
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
ft, E p .-- -- r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING (� ,3 r3
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
13 —ozJ
4 PRI0 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
r soi
I. Blue File �
2. Gold City PERMIT NO ZZ3! 1
i
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
J (/ /3 q ki44ev cil c4_ 2 / .
/-4- -7--/x'1 /SA
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER Qv Lh x.1 -- �
(Name) Lev (Phone) 9 t ` AF 3— fC 11
J
(Address) F ( 3 v( 1 fr J.G., Fc-J.A C4-
(Name CANT f ! lic ✓w 4,.\-. (Phone) moo? — Y�� _tom
(Address) /6 6 fr./ C n k rJ t? d `/.1 cs'Je sot el' 13 30 C , e ,''i S-\-- 7d i
(Address) (City) (Zip Code)
(Contact Person) 6Q-10-" (Phone) G / 1 36C 'II•f' `'( 2
APPLICANT SIGNATURE 7:5 DATE / j
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain / Water Softener
f Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
J Bar Sink Lawn Sprinkler s
Water Closet (Toilet) Other c. t a F ?
FEE SCHEDUL � � Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum e sidential, N e & Two - Family $149.50
Residential, Additions & Alterations 49.50 -
Estimated Cost $ Building Permit # v' v, rn t
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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