HomeMy WebLinkAboutBldg Permit 04-1017
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sip at bottom)
ADDRESS
/4-2-75
Date Rec' d
/0. "1. ~4-
I. White File I PERMIT NO
2. Pink City . 0 #-. / 0 17
3 Yellow Applicant
tv/t-m~/t-
/eO
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name)
V \ CK."I
,
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
c. () 6 Rc) lJC.~V
(
ZONING (office use)
te 1.r.L)
PID 25. 1JO.() 6lf~ 0
(Phone) 9 Sa) l-J40 - ~ ~ 85
,
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck o Porch iYRe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
o Addition OAlteration OUtility Connc;6i~n 0 Misc.
CODE: DLR.C. DLB.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
ill IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST/VALUE $
(excluding land)
IT
F
I
I hl'feby certil'y 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 authonzed 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.
X l/IC~e (J.Jl.J.LJluA 1()-7-0r
I Si~a~-"'" - I Contractor's License No. Date
,
Permit Valuation
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 Park Support Fee
I SAC
1 Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
Other
TOTAL DUE
I Paid
I Date
I~-f/l)
/6 ""...u ~
This Application Becomes Your Building Pennit When Approved
Building Otlicial
Dale
# $
# $
$
$
# $
# $
$
$
$ 7 (, .00
ReceipPNo. ~ 7 rJ(,.,....
BO'
ThiS IS to cenil'y 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
CITY OF PRIOR LAKE
INSPECnON NOTICE
SCHEDULED
DATE nME
~{Jas-
ADDRESS
/~~7J ~~/e
OWNER
PHONE NO.
o FOOTING
[J FOUNDATION
o FRAMING
[J INSULATION
,..l1-FINAL
o SITE INSPECnON
COMMENTS:
-~ /)
~/otJ r-
CONTR.
PERMIT NO.
o PLUMBING RI
[J MECH RI
o WATER HOOKUP
[J SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~/o/ /'
o EXIGRADlFILLING
[J COMPLAINT
o FIREPLACE RI
[J FIREPLACE FINAL
o GASUNE AIR TST
o
~ A ~
( ~/ /e.-'k.
----
./ ~
( -"'""' / ~ "/ )
\. 6/d.1e /--r ~ ./
~wo~~eTeRV.PRee~~u ~
~CORRECT ACTION AND PROCEED
~
[J CORRECT WO~,....C~LYOR REINSPECTION BEFORE COVERING
Inspedor: /' ~~ Owner/Contr:
,
CALL 447-9850 FOR THE NEXT INSPEcnON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
IN6NOTl