HomeMy WebLinkAboutBuilding Permit 16-1006 qq DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE /SCHEDULED U Z5 L
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ADDRESS _
OWNER CONTR.
PHONE NO. PERMIT NO. i fo
0 PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOOTING
❑ FOUNDATION 0 MECH RI 0 COMPLAINT
O FRAMING 0 WATER HOOKUP 0 FIREPLACE RIAl—FINALCE FINAL
P
FIRELA
p INSULATION 0 SEWER HOOKUP 0 FIREPLA AIR TSL
Al—FINAL 0 PLUMBING FINAL 00
❑ SITE INSPECTION
0 MECH FINAL
COMMENTS: ' 4JA
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-'Id-
WORK SATISFACTORY,PROCEED
0 CORRECT ACTION AND PROCEED
0 CORir
i•-K,CALL FOR REINSPECTION BEFORE COVERING
Inspe
rOwner/ContraC447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
.$ roe.00
4 PRto4,
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
)-' TEMPO ARAND UTILITY CONNECTIOCERTIFICATE OF N PE COMPLIANCEG RMIT 9 . /6
I.white File2. Pink City PERMIT NO.
3. Yellow Applicant / /(f `a
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
\ i' Jk‘ k\\41, V '
VMaPerfs�
LEGAL�DESCRIPTIION(office use only)
LOT `.'BLOCK / ADDITION Ce-41/2/2((S l 4°'I✓ �j' '7 ., /w/,f I►, 5.--.3/2 '06 3
(OWNERV o I X \ 4\ \W�J 1 1 V P (Phone) V1.1 ifr n5`i
(Address)
BUILDER l �/( _ r ,�(CompanyName) \` ,Ni \ UncW\ALtc1V (Phone)�� 9)b\—)U�(Y
(Contact Name) tt At _ (Phone)
(Address) -A0 i&\‘c\q\Colf t--1 I i 1 1 .&c '5 o 1 1
TYPE OF WORK D New Construction ODeck DPorch ' Re-Rooting ORe Siding OLower Level Finish 0 Fireplace
DAddition DAlteration ❑Utility Connection
: DLR.C. D.B.C. D misc.:Construction: I II DI IV V A B (�
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ L0 Ott
Division:IIE
1 2 3 4 5 (eacludIng land)
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 constmction will conform to all existing state and local'aws and will proceed in accordance with submitted plans. I am aware that the building
o can revoke this puma forjust cause. Furthermore.I hereby agree that the city official or a designee may enter upon the ptopetty to perform inspections.
X \i\33aVak- c'krer2 t G li 151(1,2:1 th 14/
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 10
5.
(7 )) Water Meter Size 5/8";1"; $
State Surcharge $ ` Pressure Reducer $
Penalty $ f . (ft) Sewer/Water Connection Fee - # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $/01/c_ C0
This Application Becomes Your Building Permit When Approved Paid ®I/ Receipt No.(o��S
Date q (, /` By
. Building Official Date
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 Occupant;must be
issued.
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