HomeMy WebLinkAboutPlmbg 09-0374 & 09-04340
5' (") 000000 "0 0 > -0
(/l 0 ::t ~ 0 z_
~ C/)"Tlz"Tl"Tl"Tl 0 0 ~~
g 3: ::::jzC/)~OO z m :a mO
3: m>c CO m :;c m 0"Tl
_,>3I:Z-4 en
m z ZCz z en ::!"O
Z ~ ::1G'l~G'l 9 O:;c
z-
" -I m 0 - zO
V\ en o Z 0
-4 Z 0:;C
~ ('> (5 ::!>
Z 0"
~ 0 > mm
>
~ :;c r Z
r c
~ -4 "Tl "0
~ ::t 0 :;c
~ m :;c 0 000000
Z :;c 0
~ m m m 3I:"OC/)~3I:"O
>< m
-4 Z c mr~>mr
C/) oC -40C
;t ~ Z ~ "0 ::I:3I: m::I:3I: "0 en
~ en m "Tl!:!!:;C:;C:;C!:!! m 0
~ "0 :l 0 ZZ::I:::I:-Z :;c ::t
::! m CD -4 >G'l00 G'l 3: m
:::t 0
~ 0 0 r"TlOO :;c ::::j C
-4 0 Z -"" - c
~ (5 ~ tll zcc Z ,
Z m ~"O"O 9 m
~ N "Tl C
,.. 0
~ ::t :a
m
~ 0 0
c 0
:;c < 'm;D 0 0 0 0
C/) m ~~
~ Z :;c G'l"Tl"Tl0~
> Z >;;;;0
~ 0 G'l ~mm~G'l 0\ m
~ < _"O"O"O~
>
;;J Z ~s:>>c
0 >ooz:;;
~ rn _mm-4_
-. :;c "Tl :;c r -1
-4-- r i
C/)Z Z m
-4~ G'l
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFIC ONING COMPLIANC
AND Y CONNECTI PERMIT
fLMI
/t~/ff ..I>lC.f
File
City
Applicant
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) V,1 AI J /C t.. 1(.
C' r"'?7 / T /'/
(Phone) ~~~ -9~~' 7~.A.5'-
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe.Roofing ORe.Siding OLQwer Level Fimsh
OAddition OAlteration OUtility Connection
{L(L,G..
CODE: DI.R.C. DI.B.C. o Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
PROJECT COST IV ALUE $
(excluding land)
I hereby certifY that I have hlrmshed mt()rmation on this applicattOn which IS to the best of my knowledge Irue and correct. I also certtfY that I am the owner or authorIzed agent t(Jr the
above-mentlOned property and that all construction Will conform to all eXlstmg state and local laws and will proceed in accordance with submitted plans, I am aware thaI Ihe buildmg
official can revoke thIS per~tl for Just cause Furthermore, I hereby agree that the Ctty official or a destgnee may enter upon the propeny to perform needed mspectIons
C" .,
X 4./~(~-JU'-r~/ J/7~L--~5
Signature
,//../:.0 6 (l t'
, Date
Contractor's License No.
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $ '"
,~J
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 5G. .-
I ~~ceiPt NoliP/!- Z
Paid
Date
tfr ~~1
ThIS tS to certtfY that the request in the above applicatIon and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested TIllS document
when signed by the Ctly Planner constItutes a temporary Certificate of Zonmg compliance and allows constructIon to commence, Before occupancy, a Certlficate of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
t . Z~o' 0-;
1. Blue File I PERMIT NO A. I
; ~~:~w ~~~licant . 09. O~.3lJ
ZONING (office use)
Hk/
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) JJA P J .e '"
-jJ /n I r#
(Phone) 9f"z, - ftftf-7tf2. .r
(Address)
APPLICANT
(Name) ];)19 A,lIAL.
~\~/r,4
-
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE t
Quanti
APPLICANT PLEASE COMPLETE BELOW
T e of Fixture Quanti
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavato Bathroom Sink
Laund Tra (lor 2 com artment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet
e of Fixture
Machine)
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildine: Official
Date
Paid ..57J ~ f/V
Datet . 2-" ~ ()
No. 59 Z13
24 hour notice for all inspe Ions (952) 447-9850, fa (952) 447-4245
4646 Dakota Street S..' . esota 55372