HomeMy WebLinkAboutBldg Permit 04-1030
//~Y'
I' .
S-77'7 Oct'L</d
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: /) /?
,~erO~,f
DATE TIME
c~:- /(')-5>0
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASlINE AIR TST
o
.~ /
//~~/
/7/7 // /-
flkoo r 4d~S d/c,
-f-Po ~. _~e /? Y/7frJ ~ J
, /P../_
~
/WORK SATISFACTORY, PROCEED
(2 ~ORRECT ACTION AND PROCEED
o CORRECT WO.:>.Mo/ff'-.Yr'EINSPECTION BEFORE COVERING
Inspector. /' ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2 Pink City
3 Yellow Applicant
PERMIT NO. 04-. .1030
(Please type or print and sign at bottom)
ADDRESS
571-r
(!,{;v /f1e,-t--1/ 0 cJ 0
> I
LEGAL DESCRIPTION (office use only)
LOT / ~LOCK 2 ADDITION
~~
PID ZS-:
S/rA/o
OWNER
(N ame)
~
". ).-c~)~(.c.,
Date Rec' d
/'C/ II 04-
ZONING (office use)
put:)
Z:S9.05Q 0
t /
/r,( 1? ('OL4'u-...
(Phone)
'{9.- tor-OY(J0
2", I v:' 1<-., ? ~/,'L
, ..
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch tfJRe-ROOfing ORe-Siding
DAddition o Alteration DUtility Conne{:.tion 0 Mise,
OLower Level Finish
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
fillV V A
HIM R
2 3 4 5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I
E
II
F
I
o Fireplace
I hereby certity that I have fi.lfnished information on this application which is to the best of my knowledge true and correct. I also certity that I am the owner or authonzed agent for the
above-mentiOned proper hd 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 thO ermit ~use ~mor~y agree that the city official or a designee may enter upon the property to perform neededmspections. ~ /
X ~. /C,-//_____ 1/)_1/..0'1
j.81'''gnature/ - Contractor's License No. Date
$
$
$
$
$
$
$
$
$ ~0< 0-0
~;ce~-Je-n
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"; 1";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
-; <;- ~. (/U
Id II, c) t7---
Paid
Date
Building Otlicial
Date
ThiS IS to certity 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, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372