HomeMy WebLinkAboutBldg Permit 04-0591
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
White
Pink
Yellow
File
City
Applicant
Date Rec' d
I PERMIT NO. tJt(./ 5JL
ZONING (office use)
/Sf(0~
,
cOrrie ~..~
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name)
'\ ~l^^- .t
(Address)
BUILDER G
(Company Name) '~
(Contact Name) ~.-~,~
(Address) 14{; 7..:1-
b ~V\<.( S.evl+Y y-L
(Phone)
'"3~ ~sl-,
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h/," iJs D)( ~~
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-:LYle..
(Phone)
(Phone)
PID2S. 03 'Z- . Oct)" 0
qS-J - 447- Lf 300
1sJ - CrcJ J- -7 &5- =$
(P1:J-~l-jJ- -",q7C'1
,
TYPE OF WORK 0 New Construction ODeck OPorch '~e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddition OAlteration OUtility Con~-~ 0 Misc.
CODE: DI.R.C. ftlI.B.C.
Type of Constmction: I
Occupancy Group: A B E
Division:
II III IV @) A@
F H I ~R S U
1 2 3 4 5
----
PROJECT COST IV ALUE $ ~c:::Jt).
(excluding land)
I hereby certify that I have filrnished mformation on this application which is to the best of my knowledge true and correct. I also cerl1fy that I am the owner or authOrIzed agent for the
above-mentIOned operry 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
:cial can revo IS per~ for JUs ause Furthe~rebY agree that the Clry o~a(~ a de~6 ia'jn7 {J{l?perty to perform need~n~75 _ OJ
J Signature . Contractor's Ltcense 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
-
;X;OOJ-- I
$ <Kg, J-S" I
$ ~~r;. 3', I
$ /, SO I
$
$
$
$
$
:J;:::~~~dmg;;:;~'d
Building Ollicial Date
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
Paid
Date
I vi '7 I; ;
t;'-/~- '-I
#
#
$
$
$
$
$
$
$
$
$
/t./'!' / /
#
#
/r r........,J
Receipt No. '-I b K' r / I
By ~
ThiS IS to certify that the request in the above applical10n and accompanymg 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 Ccruficatc 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
SCHEDULED
ADDRESS
/_~/'r2
~~~-
CO~.
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)?FmAL
o SITE INSPECTION
COMMENTS:
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
/J /
/Lv' /"/)CJ ~
/
DATE TIME
9hk
;/ , ,
0~e..~ 4e'.
o~~/
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
/7 /l
~/ l/ _
. '?tJO T c" i'Y7Je ~ /-.5. 0/:"
() / / /1 /
1'1r~1h rh~. 07 fO J /t d
V- / '/
A
/~ORK SATISFACTORY, PROCEED
h~RRECT ACTION AND PROCEED
o CORRECT WORK, CAf.';l1~PECTION BEFORE COVERING
Inspector: Y t/ ft1' ~contr:
, r
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
i" --~.
INSNon