HomeMy WebLinkAboutBuilding Permit 04-0164
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICAIE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
3. 19.04--
I. White File
2. Pink City
3 Yellow Applicant
(Please ~J.. or print and sign at bottom)
ADDRESS
.s'-lZ" FA \1l.LAu)t\I >~O/ZE.S T7ZAtC- st=. c
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name) r~ ~ cJ7Z:::J(J,J~ I
(Address)
(Phone)
BUILDER
(Company Name) y~ 'B~\l1>e..S'f,N1SVlLO
(Contact Name) ~f2~'l", l~U'~
(Address) J~117. 6f:::t~I~ r.=J-t)€ ~L1Z lI~v fKllJ
PERMIT NO. 0+'. 0 I'~
ZONING (office use)
PIDZ5. 03/. 003.3
(Phone) q~-I.f3' -''''70
(Phone) q~L. Z9Z - 0<<614
~/Z...L{
TYPE OF WORK 0 New Construction o Deck o Porch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddition o Alteration DUtility Connection 0 Misc.
CODE: OJ.R.C. OJ.B.C.
Type of Con~~_ction:
Occupancy Group: A B
Division:
I
E
II
F
1
ill IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST /V ALUE $
(excluding land)
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 t. ermit for just cause. F ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspections.
x
I Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Signature
--
Contractor's License No.
Z, 00, tflJ
$ 7-{.1'-
$ ---
$ 1./
$
$
$
$
$
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
This Application Becomes Your Building Permit When Approved
Paid
Date
~ l# . vv _
,.. IY- (/ ,...-
Building Otlicial
Date
.3-lq-~q
Date
# $
# $
$
$
# $
# $
$
$
$ 7'.00
Receip~o. %2/1 ~
By /' /'.
r;
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, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE nilE
~~7~1
ADDRESS
SC,/14
h,,,, IO~ S4'-4.'-i
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDA liON
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
~2(~,
COMMENTS:
o EXlGRADIFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT fJJ~ FOR REINSPECTION BEFORE COVERING
Inspector: J V f Owner/Contr:
CALL 447-9~5Q F(>~ ~E NEXT INSPf-CTlQN ~4 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
L ..~ l..J,j