HomeMy WebLinkAboutBuilding Permit 04-0683
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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City
Applicant
(Please ~pe or print and siJtll at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT -r BLOCK
ADDITION
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OWNER
(Name)
(Phone)
(Address)
(Address)
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BUILDER
(Company Name)
(Contact Name)
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Date Rec' d
77.rJf-
I PERMIT NO. 64',OtP~.31
ZONING (office use)
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(Phone) 4"). -4"1 J - 5 y<(.J.
(Phone)
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TYPE OF WORK 0 New Construction ODeck o Porch ~e-Roofmg
DAddition DAlteration o Utility Conn1f-i01t 0 Misc.
ORe-Siding
DLower Level Finish
o Fireplace
CODE: OLR.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
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HIM R
2 3 4 5
B
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PROJECT COST IV ALUE $
(excluding land)
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1 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 buildmg
otlicial can revo~.2 permit for Just cause FlIrth~,~plore, I hereby agree that the eity official or a designee may enter upon the property to perform needed inspections
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Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace 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
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
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,
Paid
Date
Building Otlici<ll
Date
# $
# $
$
$
# $
# $
$
$
$ '7(, .00
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Receib.YNo. q"'71~ J .0
By L.....
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ThiS IS to certify that the requl'st in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested This document
when signl'd by the City Planner constitutes a temporary Certificate of Zoning compliance and ailows construction to commence Before occupancy, a Certificate of Occupancy must be
isslled
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
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
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OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
DATE TIME
SCHEDULED ~~~~
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CONTR.
PERMIT NO.
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o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS: ~ /7
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~ORK SATISFACTORY, PROCEED
h l~'ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR ElNSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
,
THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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