HomeMy WebLinkAboutBuilding Permit 04-0237
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec" d
L White File I PERMIT NO Olf I
2 P;,k C;'y . ...... '137
3,Yellow Applicant ~
(Please ~e or mint and sign at bottom)
ADDRESS
ZONING (office use)
,I2/S0
153"1~
ItollrQ S.fZ.
~ I<'~ Po 11.1...-
LEGAL DESCRIPTION (office use ooly)
LOT i I BLOCK (ADDITION IIA a u lj,
;) ft/d ({o.-Iu ~ PIDd.S-(}t!&"o//-{)
OWNER
(Name) ~\.I to mCl.~"'" ~1..hJ ~IT<-I.l-Ll"IC.IL
'l\i"2--Y'-Io- 1(4"'-1\1
(Phone)
(Address) I ~ t...I ~ I<:;>l- OIlIIJ'r IU:> ,,-0 "C:
BUILDER
(Name)
(Contact Name)
(Address)
~<.. {OAY-r
iLc-~" I r;; 10 ~<;.
ST ~CLlh.lr.c... ~
<\'>:"L'1I4, . 1~32
(Phone)
(Phone)
au,."
rl..,}
SS3>7?
Il..02-0
d" ~
}tfRe-Roofing
DAlteration
TYPE OF WORK
o New Construction
ODeck
OPorch
OAddition
ORe-Siding
DLower Level Finish
o Fireplace
DUtility Connection
o Misc.
PROJECT COST IV ALUE (excluding land) $
I hereby certify that I have furnished information on this application which is to the best of my knowledge hUe 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 Y' ~y';'nJ to perform needed inspections.
X IL -M_ t, ~.~A-J
Signatutl
4- 'l.- 0\.1
Contractor's License No.
Date
I Permit Valuation
I Permit Fee
I 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
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
$
$
$
$
$
$
$
$
$
,~5 M.------
$ It!, 7~
$
$ 1'<35
$
$
$
$
$
#
#
#
#
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I Receipt No.
Bv Vi
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This Application Becomes Your Building Permit When Approved
Paid
Date
Building Official
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 Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
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
Planning Director
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNOATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
/
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~
DATE TIME
S9HEDULED ~L(,1L(
t::rsl-t (ff (td
/ .{'jt1t...(
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~
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(-1) ~ \
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~OJ!K,~R REINSPECTION BEFORE COVERING
Inspector: I V r Owner/Contr:
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CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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