HomeMy WebLinkAboutBuilding Permit 04-0352
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICAtE OP-ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
I. White File
2. Pink City
3 Yellow Applicant
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LEGAL DESCRIPTION (office use only)
LOT B' BLOCK "'2- ADDITION IJ L V' I cW :l ~
OWNER
(Name) C~'^"-J ~\o~
(Address) I (gol.f5< tJrrrt,^WObJ f.J. tV J
BUILDER
(Company Name)
(Contact Name) _
(Address)
Date Rec' d
f. U"O 4-'
PERMIT NO. ()tI-.03SZ-
ZONING (office use)
I!:-f .J't)
PID ~. -a.-UJ. al '. L>
(Phone) ~ - lj'f6 .. g ~ ~ q
(Phone)
(Phone)
TYPE OF WORK 0 New Construction o Deck o Porch l2f'Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility Conn&-n 0 Misc.
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
ill IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST IV ALUE S
(excluding land)
IT
F
1
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 enter upon the property to perform needed inspections.
X ~ t.~::f:;;( Contractor's License No 't (,).5 f.~'f
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Z,S7J1>..f'U
Park Support Fee
SAC
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
I Paid
I Date
'?t,. fJ t:/
~,.>'Ir t1~
Building Otlicial
Date
# $
# $
$
$
# $
# $
$
$
$ l(,~ ulJ
/)
Receipt 1'16. ~~7
By 0'
Thts 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
ADDRESS ~
OWNER
PHONE NO.
o FOOTING
o FOUNDA liON
o FRAMING
~SU~
.. 0 S: INSPECTION
COMMENTS:
DATE TIME
..
SCHEDULED ~ ~ ~ (
~
CONTR.
PERMIT NO.
L/ _ ~:2-
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADIFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
No .tJ? lb..~
./
X.WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: (/:t; Owner/Contr:
CAL"-df FOR ~E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE RE "REM~ ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/ msNOTl