HomeMy WebLinkAboutBuilding Permit 04-0542
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. ()~, ().5+z.}
(Please :tYpe or print and siltD at bottom)
ADDRESS
1-f-/o'1
/l j' ~ t:Jt/ /tV e
LEGAL DESCRIPTION (office use only)
Date Rec' d
(p.4-.() 4-
ZONING (office use)
p(.lO
LOT
PID 2.S":" 2-39. 6"? /, 0
BLOCK ADDITION
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OWNER
(Name)
(Phone)
'f. (;;2 - tjtlS- L/.t; ~
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK. 0 New Construction DDeck o Porch ~e.Roofing ORe-Siding DLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Conngn 0 Misc.
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
I Division:
B
S U
PROJECT COST/VALUE S
(excluding land)
I
E
II
F
I
illrvVA
HIM R
2 3 4 5
cd 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 fOf the
W an t at all construction will conform to all existing slate and local laws and will proceed in accordance with submitted plans. I am aware that the building
permi fi Just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed 16ct:if-(::;Jt/
Signature Contractor's License No. Date
$
$
$
$
$
$
$
$
$ '/fn. tJ 0
I ReceiDvl~/ "r6 '1/tI
By AtIt lL-
I
X
p~;ua~ion
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Park Support Fee
SAC
#
$
$
$
$
$
$
$
$
#
Water Meter
Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
Water Tower Fee
Builder's Deposit
Other
#
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
70, . 0 0
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Paid
Date
l3uildingOllicial
Date
ThiS IS to certify that the request in the above application and accompanying documents is in accordance with the City Znning Ordinance and may proceed as requested This document
when signed by the City Planner conStltutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certlficate of Occupancy must be
issued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
~s/ar/ TIME
. /
/~o 9 ~/t!'''- .4<e.,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
/
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
AESULATION
, INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: /7 /)
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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~RK SATISFACTORY, PROCEED
~~'ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~
Inspector:
Owner/Contr:
CALL 447.985Q FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
"'''"'''
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!