HomeMy WebLinkAboutBuilding Permit 04-0235
(Please type or print and sign at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICAIE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIt
1. White File
2. Pink City
3. Yellow Applicant
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LEGAL DESCRIPTION (office use only)
LOT!/BLOCK0 ADDmON )J~ ~ (.sf
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OWNER Air. V\ r i I
(Name)~
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
Date Rec'd
;~ 8. D~
PERMIT NO. tJtj- (JzJS-
- ZONING (office use)
fel
PID~5'- t25~- OIO-'{)
(Phone>(!S-'1)440- l/J9J
(Phone)
(Phone)
o New Construction
o Deck
ORe-Roofing
ORe-Siding
OUtility Connection
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
;ter UPC ~ ~eeded inspections. Cf-O N' -0'1
SilrUture Contractor's License No. Date
Permit Valuation
Pl:.uuit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Pcuuit Fee
Gas Fireplace Permit Fee
o Porch
OLower Level Finish
o Fireplace
OAddition
OAlteration
PROJECT COST IV ALUE (excluding land) $
$
$
$
$
$
$
$
$
Park Support Fee
SAC
Water Meter Size 5/8"; 1";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Al'l'&'" led
Paid
Date
7~ .Cf't)
4-. (3.04--
Building Official
Date
# $
# $
$
$
# $
# $
$
$
$ 1&.0 0
()
Rece~~o. 4--vfl3~
By <""
0
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 tor all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
ISG7q
DATE nilE
L( ~IJ'--Otl
Sa~~ L-.fY
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION ~
J71iHAL yOO~
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
D PLUMBING FINAL
o MECH FINAL
COMMENTS:
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/'
/ /
I I 0>(
~
L.{-ZJs
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
D FIREPLACE FINAL
D GASLlNE AIR TST
o
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~ORK SATISFACTORY. PROCEED
(] CORRECT ACTION AND P CEED
R REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
IIUNOn
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!