HomeMy WebLinkAboutBuilding Permit 03-0104
/cYI-03
I PERMIT NO. ()3 -0/ o4-f
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City
3. Yellow Applicant
/701/
LEGAL DESCRIPTION (office use only)
( ADDITION
Date Rec' d
ZONING (office use)
LO
BLOCK
PIr:eJS- 76- Od.-/-O
I -lk
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(Phone)
H t I~\I M:/v n~
(Address)
17071
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5~ 121
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(;:)1 i01
t. ItC.. " I,J . fv\ tJ
o Porch
ORe-Roofing
ORe-Siding
TYPE OF WORK
o New Construction
Deck
OLower Level Finish
o Fireplace
OAddition
o Alteration
o Misc.
PROJECT COST/VALUE (excluding land) $
OUtiIity Connection
tJOO
I 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 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 designee may
enter upon the property to perform needed inspections.
x
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
'5l.{ ~>
--,-il~'ticense.No.
".'.~
,fii/t. .
Permit Valuation
Park Support Fee
SAC
#
#
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
J- 27- 2cc.s
$
$
$
$
$
$
$
$
$
Gas Fireplace Permit Fee
es Your Building Permit When Approved
1-)... ,,..03
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
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Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
DATE TIME
CITY OF PRIOR LAKE C-IL
INSPECTION NOTICE SCHEDULED
ADDRESS 110ft Wi /J-f/I"l-t'J> l'r 1
OWNER CONTR.
PHONE NO. PERMIT NO. -;)- 10'1
o FOOTING o PLUMBING RI o EXIGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULA TIONO ~ o SEWER HOOKUP o FIREPLACE FINAL
~NAL -('t- L o PLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
tfWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: (\;(l ~ "(j,iIj
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
-r--........'---'-...---.
..
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS I t-S~ ,.. r
TYPE OF WORK TJiii;/t -
USE OF BUILDING
PERMIT NO. DATE ISSUED
BUILDER C 4 ,. ~/- 'J"~ - 1./,"
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
-)?,
INSPECTOR DATE
. I FOOTING I IIlIV' I S--,J-~-rJ1;
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I_R/\MIU9 I I
I FINAL I VlL)f I {.?' { 1- 0>
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-9850
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