HomeMy WebLinkAboutBldg Permit 04-1132
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3 Yellow
File
City
Applicant
PERMIT NO. O~,,/13Z-
(Please type or print and sign at bottom)
ADDRESS
/4'37~ L)oV6
u.
LEGAL DESCRIPTION (office use only)
LOT.3 BLOCK I ADDITION
/CNDd HIU-- STJI
OWNER cl
(N ame) ~(.;Jf,V\
D. ~~G:Y\
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
Date Rec' d
I ~ 1,1 04--
ZONING (office use)
~I
PID Z-6-~';>'tJ . 6 O~" 0
'15d-J33 ' 3737
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ~Re-Siding OLower Level Finish 0 Fireplace
DAddition o Alteration DUtility Connection 0 Miscr
CODE: OI.R.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I
E
II
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 authonzed agent for the
struction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
':;'rthamo", I he.::y "ll'ee that the <>ty offidal 0' a d"tgoee may eota upoo the ptoperty to pmoon need'; ;7i7 at-!
Contractor's License No. I tate
x
./
c.,.,...-
Permit Valuation
Park Support Fee
SAC
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
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 Permit When Approved
Paid 71. -
Date //., ~~,~
Building Otlicial
Date
#
#
$
$
$
$
$
$
$
$
(/
Rec~No.
BY{;~
'7(,,, '
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#
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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
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
DATE TIME
CITY OF PRIOR LAKE ~
INSPECTION NOTICE SCHEDULED
ADDRESS J<{J7 & /~ ~+~
OWNER CONTR.
PHONE NO. PERMIT NO. {-/I.)L
o FOOTING o PLUMBING RI o EXIGRAD/FILlING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
~ULATION . o SEWER HOOKUP o FIREPLACE FINAL
AL ~(a. ~ o PLUMBING FINAL o GAS LINE AIR TST
o SITE INSPEC .."".. o MECH FINAL 0
COMMENTS:
){ WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORR" WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CAL~ ~o FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl