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OF PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
o TEMPORARY CERTIFICATE OF ZONING COMPLIANCE _ ` 3 AND UTILITY CONNECTION PERMIT 1 v m
/
4%4FSOSt. I White File 3
2 Pink City PERMIT NO.
3 Yellow Applicant -
(P P+e or rint and sign at bottom)
ADDRESS 1.41 cs 14 4.4.vvinAs y l iJ- y —‘,-.. "T1r2A-.57._ ZONING office u 1
( -te LrKg ) Th N 553 / '--
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) \A.) Ct L - C - ' 0 641 . IG.'iy3 ° S xi K . 62 (Phone) q5 ?-3 " 3 -- O
i
(Address) L 1p t 3 14 LiLigA vn rj 6 -7,'2.4 a pi_ / (r 1 �+ N'! A• J 3 4 Z
BUILDER
(Company Nam.) 3 t C (Phone)
(Contact Name) (Phone)
(Address) , J
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing DRe-Siding @QLower Level Finish ❑ Fireplace
❑Addition DAlteration ❑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 HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certity that I have furnished information on this application which is to the hest 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, I hereby agree that the city official or a destgnee may enter upon the property to perform needed ms.ectiu
I X W 1,[r E? Nj A- I /y !
1 411=0 Contractor's License No. ate
Permit Valuation 0 0 0 . 00
Park Support Fee # $
1 ,
Permit Fee $ 3/ 75 SAC # $
Plan Check Fee $ — Water Meter Size 5/8 "; 1 "; $
State Surcharge $ /, 0 D Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 4" 50 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
—
Gas Fireplace Permit Fee $ 5 Q . 5-0 TOTAL DUE $ /14, 7.�
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9
This Applicati Becomes Your Building Permit en Ap roved Paid l 1 Receipt No. �j g - 1
/44 i ( 13 Date I(17 I '- By
Building Official Date
This is to certi that the request in the above application and accompanying do ments is n accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed t e c y Planner constitutor l temporary Certificate of Zoning omplian and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
1 !6 / 3
Pianm !' - tor 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
PRI0R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 4./3 U P1 bi
NATURE OF WORK Z.
USE OF BUILDING /A'
PERMIT NO. DATE ISSUED • 4
CONTRACTOR PHONE 0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
IMP
1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING fib I 20 f X S
INSULATION f Z5/,
ELECTRICAL
PLUMBING c
HEATING (if required) , A
FIREPLACE P,Y 2p1 z°
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I �
FINALS
BUILDING ( 1- - 6 1 _ ( '3
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