HomeMy WebLinkAboutBuilding Permit & Plumbing Permit 13. 0332 P. \e CC Q ..
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of PRI, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ;
AND UTILITY CONNECTION PERMIT 3 - /3
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4,„„.68cop. I. White File
2. Pink City PERMIT NO /3 33 Z
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 7-.. 133 .041 . b
OWNER IW \� �� try ��� 9 D- .Z t 1 11.R?
(Name) , ( Phone)
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(Address) L
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch URe- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Connection T c
CODE: ❑I.R.C. C!P.B.C. OMisc. 2_0Q \ \ 0 J�Q
Type of Construction: - I II III IV V A B
Occup ancy Group: A B E F HI MR S U PRO OST /VALUE $
(excluding land)
Division: 1 2 3 4 5
I her - • ty 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 ur authorized agent for the
aboi'e -mentt ed propel 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
Tt A offici 1 ca ev e This pe for Just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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Signature Contractor's License No. . Date
Permit Valuation -�QO, Park Support Fee # $
Permit Fee $
2-5_ — SAC # $
Plan Check Fee $ ((o 7--S Water Meter Size 5/8 "; 1 "; $
State Surcharge $ s-, Pressure Reducer $
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Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $ .
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ `- k r 7;
This A . icat' in : • comes Your Building Permit Wh - Appro - d 'R. 1 < Receipt No. 1P gg 7{a ate By C
..i off --- 4 2- ,- 1 13 1 13 i It.3._
Building Offie7 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
when signed by the City PI •er constitutes a temporal .of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. / 7 _ ho,,, e GCcraP.vt`l� /'Zrhait /. -0
/71 Planning Direc Ir 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
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O i PR/0, Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File
2. cola City PERMIT NO. tS 3 22—
3. Yellow Applicant
gleaactype-nto nt and sign at bottom)
9 ADDRESS \ ZONING (office use)
Z 91- 5 r: L_o.L r�,
1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) ) ( ® \c r, \X.q g,,S (Phone) l - 51.- - Z r 7? CY
(Address) 7-19 6 5 (r; c L\
AP T r
(Name �i 'Z__ v c)i, ( Phone) 9 2- "_Z (Z . /6 34
Address)) V� � P / U t �.�k, �.r-� _. c � C' G� ) �� TZ_
� (Address) (City) (Zip Code)
(Contact Person ') k.5� . $ L
( ► (Phone) Z '_ `Z ,— -
APPLICANT SIGNATURE , . - DATE 0 Z
APPL ANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Z Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family l% 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 $ ! , SZ)
STATE SURCHARGE $ - O''"
TOTAL PERMIT FEE $ 1— •
(Office Use Only)
/
This Application Becomes Your Building Permit When Approved Paids ) Recei . t No. & 06 ¢/
Building Official Date Date � , � eJ 1 $ (�
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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White - Building
4,,NNEsd. Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted / ' Accepted With Corrections
Denied
Reviewed By: 5 Date: 1.
--- ,7 3 - /3
Comments:
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"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."