HomeMy WebLinkAboutBldg Permit 03-1160
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
Cf.3.03
~. ~i~i~e ~:;y I PERMIT NO. A") -(1/ 0
3. Yellow Applicant V"..J fIJ
(Please type or print and sign at bottom)
ADDRESS
J{,730
jt/o~7lINo()O
teO
ZONING (office use)
/c/rD
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25, 133" _ ex;, 2-. 0
OWNER
(Name)
(Phone)
(Address)
BUILDER _
(Name) ~('r~o.r \.4 Jvv~d<.1\ "1>
(Contact Name) 00 l..-_..) ~ rc.>rr-..J
(Address) \ a.; y'J 1> -:Q-O th s:--t
OLower Level Finish
"'1":'", <- (Phone) Cj n.. - ~~- P~O~)
(Phone)
l ) ~IA.) Q-'-:J V-- (Y\~ ~l::.()'))
ODeck o Porch ORe-Roofing ~Re-Siding
o Fireplace o Addition o Alteration OUtility Connection
TYPE OF WORK
o New Construction
o Misc.
PROJECT COST IV ALUE (excluding 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 construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am awarfat the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~ter~:to/r orm needed inspections. q I~ I b >
~ V'ignature Contractor's License No. I I Date
I Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
I State Surcharge $ I Pressure Reducer $
I Penalty $ I City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ '7(g. 0 0
This Application Becomes Your Building Permit When Approved
I Paid
I Date
7~.OU
t!1_ ? 0 ~
f'1
Receipt -ho.
B{;~
~~f
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 I
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
DATE TIME
CITY OF PRIOR LAKE f!7 ~ _ /
INSPECT/ON NOTICE SCHEDULED --Y/-0~'-
ADDRESS /b/~50 ~#~OO {
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,Ji!-FINAL
o SITE INSPECTION
COMMENTS:
4 /
~...s~"d e.
----
)
/7 h..- ~
.-------
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
/? /' I'
La/-Art2- re
,
~----
--.:::;:::::::---
--........
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03 -//~o
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASlINE AIR TST
o
/ /'
( C'/oS-e
'- - ---
PORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~
Inspector:
.~
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
ININOTl