HomeMy WebLinkAboutBldg Permit 04-0670
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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City
Applicant
PERMIT NO. 04' ~ 0(,1D
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
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LOT BLQ6K ADDITION
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OWNER -/ // / I
(N ame) ~ T e iJ..e /<:..0\11() ~ hS
Date Rec' d
1. z.~o4--
ZONING (office use)
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(Phone)
1~;' l{~/O "A lJ
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
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TYPE OF WORK 0 New Construction ODeck OPorch ~e-ROofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility Conn~'~ 0 Misc.
CODE: DI.R.C. DI.B.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 filmished 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-menu ed 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
;dal cao, ~h~ "",mil fa< JU' .., U 1h",nore, I h,reby aw" that th, ,ily uIfidal 0' a d"igo" may ,ot" upon th' ptope<ty to p"fo,m 0"d'77i'4 Lf
Signature Contractor's License No. Date
$
$
$
$
$
$
$
$
$ '1~ .OtJ
/1{
Receipt~. #~z., ~
By (f'
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 Permit When Approved
1f.4 . C/O
7- t.. ,,0 ~
Paid
Date
Building Otllcial
Date
ThIS IS to certify that the requcst in the abovc 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
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
JO,-/o
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.....a--FINAL
o SITE INSPECTION
DATE TIME
SCHEDULED ~~
r:;;,h.n/e<..J /1"
CONTR.
PERMIT NO.
o~ -'b70
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS: /J/l
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""~ORK SATISFACTORY, PROCEED
I d CORRECT ACTION AND PROCEED
o CORRECT WOR~:JI'.y;a'{EINSPECTlON BEFORE COVERING
Inspector: /~ - Owne rICo ntr:
- v .
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl