HomeMy WebLinkAboutBldg Permit 04-0201
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
tJ15s f/ t(Y(A! J1 Cur fe-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ^ ADDITION X
OWNER
(N ame)
(Address)
BUILDER j 1 J::< ", r. r
(Name) ~y W$e Y r KJOrl i1J
(Contact Name) fV\ JC...e
(Address)
"30LJ
TYPE OF WORK
o Misc.
w ~ut11 ,_)1-
o New Construction
OLower Level Finish
I. White File
2. Pink City
3. Yellow Applicant
(Phone)
Date Rec ~ d
~ )'"O~
PERMIT NO. 04-. OW /
ZONING (office use)
PIDdY /~/}~()()~- 0
.-//1('
(Phone) ~ ;]-<(Cj JJ - jJ>~:L
(Phone)
(}(j vI ~ 11
o Deck
~e-ROOfing
OAlteration
o Porch
o Fireplace
OAddition
ml'J :; )3):' -
ORe-Siding
OUtility Connection
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 prop~ ..;0 perform needed inSpectiOn.s.
X ~~ /-xzt~ aO; J> ~/ -7 5- 3/3J Ja Y
" 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
PROJECT COST IV ALUE (excluding land) $
Z/f1J1J,q1)
$
$
$
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
Park Support Fee
SAC
Water Meter Size 5/8"; 1";
Pressure Reducer
Gty SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
. Paid
Date
7 (, .(/ t"J
:3. '::J I./J 9--"
# $
# $
$
$
# $
# $
$
$
$
. Recei~.
By (//
1&.00
~(I ~ 'I-
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 Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED Ci -I () -ot..j
~(IR ~
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
L(-~I
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
KFINAL 0 PLUMBING FINAL
.,/ d. SITE INSPECTION 0 MECH FINAL
-%o*,
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
/"'" ,
./ j) N1 nlfO -{ V
~'I'\.i rt-
~'SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspeelor. I$fr
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
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