HomeMy WebLinkAboutBldg Permit 04-1117
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERl uICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sip at bottom)
ADDRESS
J 6 ~ /~ M,,!j ~~( k;!
LEGAL DESCRIPTION (office use only)
Date Rec' d
I. White File I PERMIT NO
2. Pink City .0 /. ~ _ / / /r-?
3 Yellow Applicant ..,. r / , /
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LOT
BLOCKX ADDITION
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OWNER C I
(Name) r~e- t:
.ILL '.r _ r
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(Address)
BUILDER LJ /
(CompanYName)~_ r-
{Contact Name) A- .P-- /
(Address) 7d '" 11/"~LU-".,/
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(Phone)
(Phone) ~ /),.
(Phone)
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ZONING (office use)
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TYPE OF WORK 0 New Construction ODeck o Porch ~e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
DAddition o Alteration OUtility Connection 0 Misc.
CODE: DI.R.C. DI.B.c.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST /V 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 aware that the building
;cial can revC?-:t for just caus~~ee that the cityiCc 0: a ;;j maj e:f ;~2roperty to perform needed mspections.
Signature Contractor's License 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
;;;'~~O().-- I
$ 7~'l~ I
$ I-~~I
$ I
$ I
$
$
$
$
This Application Becomes Your Building Pennit When A. . '" ,ed
Building Otlicial
Date
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$ 7~,--
Receipt No. if5t"O /-;)
B~
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
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
TOTAL DUE
Paid /'l~,.-
Date /6-- ;;Lfl-L/
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
ADDRESS
/65-t/j
DATE TIME
SCHEDULED 3hSk-
, ,
~r-4oo 1
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
#-///7
[] FOOTING
[] FOUNDA nON
[] FRAMING
o INSULATION
~NAL
[] SITE INSPECTION
[] PLUMBING RI
o MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
o PLUMBING FINAL
[] MECH FINAL
[] EXIGRADlFILLlNG
o COMPLAINT
[] FIREPLACE RI
[] FIREPLACE FINAL
o GAS LINE AIR TST
[]
COMMENTS:
/ /)
/Leroo {
/'" .I /
Coh't/ Ie te
~..__...- ~
/ 4/7 ..,</ ~
(' C-laS'-C h/e /
"--- ----
~RK SATISFACTORY, PROCEED
[]CORRECT ACTION AND PROCEED
[] 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 cl SAFETYI
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