HomeMy WebLinkAboutBuilding 04-0645
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OS/21/2004 14:01
5127585112
NIEMAN COMPANIES
PAGE 02
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
14-1 7 ~
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2 Pink
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File
Cily
A~pli~a.I"
I PERMIT NO.v </-. u~4~-J
I ZONI N b-;;;;;;;; ;;;;- -I
__ I
8,'or
Lake:..
LEGAL DESCRlPTION (office use only)
LOT
BLOCK
APDITION
"-'-""-''''.' -..., '---"'l
PID2~)- .')e..~'.~ 0 (i' S"~_~~_,._...J
$ +~ phe.n. N e....'/ c:..~ n
p. O. &)1 .:1'17 #;tJr
BUILDER /J,.., /J
(Name) N;e~ ~~ L.:cHT\Pa."l..(
(Contact Name) IDrt\.. JJ i,. I'Y\ a n
(Address) R. D, go /. ~ ~ New P f"t\... ~ e m tJ ~ 0 7 J
OWNER
(Name)
(A:!dress)
(Phone) ~ I'; - ? J X' ~ .5S- I ;)...
L-~
mAl
.553?cJ.
(Phone) qSd. '7Sg-"y21L___
(Phone) ____
TYPE OF WORK
OPorch
!i1Re.Rooting
OAlteration
o New Construction
OLowcr l.,.evd Fmish
o M.isc
x
Permit Valuation
Pennit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Perm!t Fec
Mechanical Permit Fee
Sewer & Water Pennit Fee
Gas FirqJlace Pennit Fee
$
S
S
$
$
S
S
$
............1
ODed:
o Fireplace
OR~'Sidin!( -..----l
o Utility Connection
OAddition
elf")
-
PROJECT COST IV ALUE (excluding land) S /
poo, e;o
{ hereby certify thllt I have furnished information on this applicatlon wlJjclJ is to the best of my ~.owledge trUe ilnd correct 1 also cet11fy ch'H I nrn. lh~ OWMr or
authorized Agent for the above-mentioned property and thar all constrUction will confonn to all existing stare and local1aw\ and will proceed in il,'("'rJiln':r WIlI1
submitted pIa r am IIW that the building official can revoke this pennlr for jusr cause. Furthermore. r hereby agree that the: city "rr'CI~1 or iI 1lt::>l)!nCc milY
enler upon opert)' to I'm needed inspections.
This ApplicatJon BeCOmes Your Building Pennit Wl)en Approved
~ ~ 6/,;2D:1' <(
Building OffiCIal
Contra.ctor'~ Uc~nse No
"~-::~/-~~
I):ll<,
__.._.__ ..1
..__..~ . .,
Park Support Fee # $
--... '.. ., '-'.-
SAC # $
Water Meter SizeS/8",1", $
_.-
Pressure Reducer $
...I'....I'.',.~_._,~_.
Ciry SAC and WAC -# $
.-,..-.........- .. ..
Water Tower Fee ;1 $
...-... ._.. '__.hn
Builder's Deposit $
--.--'''._-
Other $
""'1/'- _..- -.-.._- "--._-.. ,.....
TOTAL DUE t!4-1 toe. t-y tJ 21 oL'/- $ 3 ?.t?..~__.~.
..
_... ..1
..i
..~
I
I
..s
~?C: ex fo,-r J};'r~,-j2:2L)~~j
I Paid
Date
This !sIO "ernEy fha.r the requtSt ltIllle above 1t'pliCalion and ACl:Ompaoying ~O<:U"lelll.l is in accordance with the City Zoning Ordinann' and may I'rocffd ~s t~'1Ul'~II'd .Tj;;~-;;-<~~,-'
~hen llened by the City Planner eOlUtitutes A temporuy Cenitkale of Zoning complJan"e ..nd allows constnJclion (0 commen"e. Before oCC\JpanC)', 4 C:~rlifk",... "r OWq'olIk"Y mU\1 h"r
ISsued.
Plannilla Djre~lor
Date Spc:cjal Conditions, it ai1Y--
24 hour notice for all inspections (952) 447.98~!iO. fa): (952) 447-4245
16200 Eal::le Creek Avenue Prim I.ale". MN <;"17?
- ...._ -.-.1
~
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /~L7" 11/1;'; /Ii€.
TYPE OF WORK ~E. 'PF Pt,lfr ~dF"
USE OF BUILDING 77~iJ
PERMIT NO. DATE ISSUED' I If
BUILDER PIe1KA,.J PHONE # in -75"'- f?'/
NOTE: THIS IS NOT A PERMIT OR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
_ ......."..,. DATE
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING/ J7!fC/17h'/N(f /;-anJ-.tF':- I
, /
I FINAL I r
r
I
I
FOR ALL INSPECTIONS (952) 447-9850
"