HomeMy WebLinkAboutBldg Permit 04-1106
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND lJ llLITY CONNECTION PERMIT
I. White File
2. Pink Cily
3 Yellow Applicanl
Date Rec' d
/0, 'ZfI.04-
I PERMIT NO. () tf-" 1/ () 6
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LEGAL DESCRIPTION ()ffice use onl))
LOT /.s;LOCK
ADDITIO~ /"1l"1?'te
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(Address)
~C~~~~Name) ~e.- ~l~~_
(ContactName):.QaclJeJ ~OLJ~D'lt)ID)
(Address) 4&~3 Irl.~-..C>~. 5Av ~
OWNER
(Name)
ZONING (office use)
/U.:/,.;:}
p~.rH/)~ ~ PIDz,s-.d~<J(~ 0
(Phone)
(Phone) Q';J.-t../41- 1Sg''7
(Phone)
mtJ
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TYPE OF WORK 0 New :onstruction I DDeck o Porch 'btRe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddit .on DAltl1 ~ation DUtility Conn&n 0 Misc.
CODE: DI.R.C. DI.B.C,
Type of Constnlction:
Occupancy Group: A II
Division:
I
E
PROJECT COST /V ALUE $
(excluding land)
I hereby certi . at have furnished information on t is 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-mentl ed operty and that all construction w conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can v e th~u~ .us Fl herm re,<I hereby agree that the city official or a designee may enter upon the property to perform necded)D:~~ -0 ~
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
~I'
I
III IV V
HIM
234
A
R
5
B
S U
$
$
$
$
$
$
$
$
$
h" 1/
'/ ftJ ,,(/I
~83f.1l;
$
$
$
$
$
$
$
$
I Park Support Fee
I SAC
I WaterMeter Size 5/8"; 1";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
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ThIS IS to certify that the request in the above appIicatil m and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constl [utes a tempor1 ry Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued I
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This Application Becomes Your Building perrut When Approved
I
,
I Paid
I Date
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/ (JJ. ()..-/
/ tJ. .J.(, "f/9-'
Building Otlicial
Planning Dire/:tor
Date
Date Special Conditions, if any
~4 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
olTY OF PRlpR LAKE
I~SPECTlO~ NOTICE
SCHEDULED
'DDRESS j4-~I{ q>(~ 'f--
c .wNER I CONTR.
F1HONE NO'1 PERMIT NO.
FOOTING 0 PLUMBING RI
FOUNDA ON [] MECH RI
FRAMING 0 .wATER HOOKUP
INSULA )~ 1'" [] SEWER HOOKUP
FINAL ~ 0 PLUMBING FINAL
ITE INSP ECTION [] MECH FINAL
<<OMMENlrs:
Nt, ~\ ~j
DATE TIME
L\-o/i
q- Uo~
o EXIGRADIFILLING
[] CCPMPLAINT
o FIREPLACE RI
[] FIREPLACE FINAL
o GASLlNE AIR TST
[]
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/~ORK SA!nSFACTORV, PROCEED
I: I CORREC ACTION AND PROCEED
I:!.' CORREC~' CALL FOR REINSPECTION BEFORE COVERING
IBSpect r: -1 Owner/Contr:
, C LA 7 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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CODE i ~QUlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
I uawon
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