HomeMy WebLinkAboutBldg Permit 04-1234
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERlltlCATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/2 J1.a 1-
~. ~i~~e ~::y I PERMIT NO./) ~, 1234-
3 Vellow Applicant
(Please type or llrint and silPl at bottom)
ADDRESS " ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT 4- BLOCK / ADDITION
7777/J /Jr
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(Address) ~ - A- J+
PID zr: 072 ~ 004- _ 0
(Phone{1 < A c1J:ft{" Ce I q 7
BUILDER SELA. ROOFING & REMODELING, un
(Company Name) 4tOO.EX.CELSIORBLVD. ~J!,f.., It-
(Contact Name) ST. LOmS PARK, MN 55416 -
(Address) b/I 00 e-X?eL-~ ~ ~~ 1/ ~
(Phone) ;; I ~~ ~O?/.t'e
(it;;..;. ..
(Plione1" J.... t:1 Q 7 ~ ::2-~
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TYPE OF WORK 0 New Construction ODeck o Porch &e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection 0 Misc.
CODE: OI.R.C. OI.B.C. PROJECT COST IV ALUE $/~ ~ 1 0
Type of Construction: I II ill IV V A B (excluding land) ,
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
I hereby certify that I have ti.lmished 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 locailaws 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 ".v".....j to perform necded Inspections.
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SIgnature Contractor's LIcense No. Date
I Permit Valuation
I Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
This Application Becomes Your Building Pennit When A.. ." I' ed
I Paid
I Date
'/(,. VV /
/7, ./7 _~t...;
I
Building Otlicial
Date
#
#
#
#
~;:i No.
0"
$
$
$
$
$
$
$
$
$ 71,. 0 ()
nbl!
ThiS IS to certity that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed 'IS 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
DATE TIME
~S-
/JP7 #-'71'1/7 CI---
CONTR.
PERMIT NO. ~r-/~J>~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~ECH FINAL /J
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.At'FrNAL
o SITE INSPECTION
COMMENTS:
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-Pr/JJ41 ~tU' /JI..,-d..JA d
, , ~
o EXlGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT /~;UR REINSPECTION BEFORE COVERING
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CALL f{.,.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!