HomeMy WebLinkAboutBldg Permit 03-1014
DATE TIME
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
....-{rFINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
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o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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11"" WORK SATISFACTORY, PROCEED
/ d CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL F R REINSPECTION BEFORE COVERING
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Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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II'ISNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2, Pink City
3, Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
1(63Lf Fvn.n.k L'Y)
1-e('V' .
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER D.
(Name) r e.-~Y)I~lAet-{\ '1
(Address)
g- I. OJ
PERMIT NO. OJ ~ 10 I +-
, ZONING (office use)
PID 2S .z., (). 00 r. cJ
P1CA.ce
(Phone) '15'Q. - 'i!jJJ -?{J~
/(Mfl"Mj
BUILDER /J _ /
(Name) ~ r{
(Contact Name)
(Address) /f1(j(J Ek:c.eJ S til y- ~ J (rcR
TYPE OF WORK
~iSC.
(Phone) ~ <Z'~ ~ frJ t.{t;
J !
(Phone)
~f, I-Cjru'r... ~f'-/<,
o New Construction
DDeck
o Fireplace
ORe-Roofing
ORe-Siding
Dutility 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 certity 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 property to perform needed inspections. 'j'
X S/t<- J!\~(\ X"-'"3
Signature . COntractor'S License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
DPorch
OLower Level Finish
OAddition
OAlteration
PROJECT COST IV ALUE (excluding land) $
$
$
$
$
$
$
$
$
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
,
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fI.I.-O'!
Building Official
Date
#
#
\
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#
#
$
~ '.
,
$\
$
$
$
$
$
$ 1&. (/7/
Receipt ~.
By ~.
U
,
4-r ~ fc"
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, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372