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of PR/O CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ? -7 � 6
AND UTILITY CONNECTION PERMIT
U e=j
M'N'NESOlP I. White File PERMIT NO
3 Pink City //� 7
3 Yellow Applicant ((// i
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 7 0 $ i t PA/EA S,wr I EADOW/ LANE
LEGAL DESCRIPTION (office use only)
LOT fO «BLOCK 002 - ADDITION PN BAs A 10 r MEA pow LAME PID t , 3 -,3L 02.0 -v
OWNER -� �. � (Phone) �toR� ` — - gS'.Z --
(Name) M`L y Tie us i (i&, A4e7ll A4 D/441 5J +� i' f d
(Address) t 70g''l PHEASA -MtAe7DCU 4 AM E
BUILDER
(Company Name) 5 ELF (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ['Re-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. J Misc. 1. G IAAa RL E vvin 15t3 ROO M
Type of Construction: I II III IV V A B o.
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ �aoa -
Division: 1 2 3 4 5 (excluding land)
1 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 I am the owner or authorized agent for the
above - mentioned prope 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 revok is ! r 't for just cause. F -more, I ir - a ee hat the city official or a designee may enter upon the property to perform needed inspections. '
x �� SE3'r; 72,010
Signature Contractor's License No. Date
Permit Valuation // 0 D 0 . 0 0 Park Support Fee # $
Permit Fee $ 3 4- 76 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ S 0 0 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 $ 3 9 7S
- � ll
,,�
.
This Application '- , • s Your Building Permit When Approved Paid 3i9, 7S R•.� Ipt No. � /3.�V
9 -2 / d Date / U
♦ dri
Bu • g Official
Bu
This is to certi t at 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
P RI R LAKE ,
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS / 7.0e `- n 5� tlEn C P✓ z A/
NATURE OF WORK LET #1/(...
USE OF BUILDING L- OII✓E/2 G-E1/z-
PERMIT NO. /0. 7.5q DATE ISSUED 9 7 /0
CONTRACTOR W1/0/2..- PHONE 44 f5
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
Imam I i
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING �. q b 1A°
INSULATION ! .
ELECTRICAL
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING G` /� 2
ELECTRICAL
OEM
l
HEATING /% / 4/---
DO NOT OCCUPY UNTIL = • E HAS BEE IGNED
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