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OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
OF P1144 . /, , /2
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE !�
AND UTILITY CONNECTION PERMIT
rn
I. White File I PERMIT NO. / /4_
y�NNESo�� -.- / 2. Pink City i Z /
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
j
ADDRESS �F� 05v,-). ..p,........4.4..._ �v �, }
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER (Phone) c/ Z 2-u0-401
(Name) 2"-v,'(__ S:ttawt .w�SS `
(Address) (c (.t,(4.)() -e-9..{fl}`. pt.,..� / . Pf' N
BUILDER (Phone)
(Company Name)
(Phone)
(Contact Name)
(Address)
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing GRe-Siding %Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
0 Misc.
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify ct. I also certify
at I
r authorized agent
r the
above-mentioned that I have
property
and that all construction on onwill conformis on which is to theto all existing state and loest of ctal laws and will proceed iny knowledge true and eaccordance with stbm submitted plan owner
I atm aware that the building
P P eY<
official can r •tit' permit j+r just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed tn��n
s.
X llContractor's License No. �7// Date
Signature
r�
Park Support Fee # $
Permit Valuation 4t 0o 0 U a # $
Permit Fee $ SAC
Plan Check Fee $ Water Meter Size 5/8"; 1";
$
State Surcharge 2 - 00 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ -5-1- Water Tower Fee # $-1-. 5—� $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other
•
Gas Fireplace Permit Fee I $ �-------
TOTAL DUE $ r 4-3. 7.5-
ipt 6�8 I
This Application Becomes Your Building Permit When Approved Paid / �J.
RI7r
Date -2...,_, /(i,. /t_-� BeY No.
Building Official Date
This is to certifythe
request
rero acs uning cmay y, eed as ted. This tst
nt
when signd by the City Planner cstitutes a temporary Certificate of Zoning compliance and allows construction tthe ocommence. Bfore and
aCttifcatofOcctpancymube
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 R I O R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 3 g •
NATURE OF WORK
USE OF BUILDING
PERMIT NO. DAT SUED Zr •
CONTRACTOR PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELO
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
11011.111
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING C/,�s 061/ nil--
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I _
FINALS
1111111111.1.11111111111110
BUILDING
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