HomeMy WebLinkAboutBuilding Permit 03-1157
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
OWNER
16910
ELM
03-1157
Re-Side
ADDRESS
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
CLeSE !=!LE
u . k P t /"'\.........:1. .......+n-..
Iv,1 e e e'''SOIl, L>unUIII~ .Il....p~ctor
DEe 2 2003
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
INSNon
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3. Yellow Applicant
PERMIT NO'QJ_/IF7
(Please type or print and sign at bottom)
ADDRESS
-
~ye/LI{/b
I&,tj/O an
LEGAL DESCRIPTION (office use only)
LOT 2- BLOCK I ADDITION WI f.A.,tH"JJ .J>~
OWNER
(Name)
(Phone)
(Address)
~~~)ER SyJ~ ~ID.... ~{)>V\\- ~ ~j .L 1'\ <-
(Contact Name) JSo~ t'N'SS~
(Address) d-OCf( E ~c) 5\ w~~~tv-- M V1 s':,~
Date Rec' d
c; z.. oJ
ZONING (office use)
vi
PID z~ //0, 062,,,0
(Phone) c:r<;J-7<;~ .6f.~ 7
(Phone)
TYPE OF WORK
o New Construction
ODeck
ORe-Roofing
OPorch
DLower Level Finish
o Fireplace
DAddition
o Alteration
o Misc.
PROJECT COST IV ALUE (excluding land) $
~e-Siding
o Utility Connection
I hereby ce at 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 ge 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 la . 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 upor operty to perform needed inspections.
x
Signature
Contractor's License No.
;)-w;}.. \ 1 S:l-
Permit Valuation
Permit Fee $
Plan Check Fee $
I State Surcharge $
I Penalty $
I Plumbing Permit Fee $
I Mechanical Permit Fee $
I Sewer & Water Permit Fee $
I Gas Fireplace Permit Fee $
Park Support Fee
SAC
This Application Becomes Your Building Permit When Approved
I Water Meter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
'7, ~J
Paid /lP - v
Date t; ~. (J i'
Building Official
Date
#
#
#
#
9 ,,( c.A 1,
Date
$
$
$
$
$
$
$
$
$ 'It.d()
-
rfrZ" 9-'
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
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, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372