HomeMy WebLinkAboutBldg Permit 04-0995
(Please tvoe or mnt and si~ at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White File
2. Pink City
3 Yellow Applicant
Date Rec' d
r 3 o. 04--
PERMIT NO. 0+, 09'15
l~~o'7
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2 ,'t'''' LA-~
LOT~OBLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
Iv' () PJlN () oL)
PIDzo; 1+/. o~. I
OWNER
(Name)
C'~Ptll
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
~ ~'c.- C\,,~e.-
ZONING (office use)
T<!*SO
(Phone) .YJL!} - ~ I :':) ~
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing tiRe-Siding OLower Level Finish 0 Fireplace
o Addition OAlteration OUtility Connection 0 Misc. 'f:.'
CODE: OI.R.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have nlmished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzcd agent for the
above-mentl ed property and that all constnlction will conform to all existing state d local laws and will proceed in accordance with submitted plans. I am aware that the building
;CiaJ can oke this:er,or ~lse.(Oh:or~ ~gree that the ci fficial or a designee may enter upon the property to perform needed7;ClI:S. } ~ ,J
( Signature Contractor's License No. ----7 ~
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
$ ~ 11/. tJ jJ
Rece~No. n 8'HP
o'
III IV V A
HIM R
2 3 4 5
B
S U
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
TOTAL DUE
This Application Becomes Your Building Permit When A..... I ed
Paid
Date
'7(,. C/l)
/O,I,,()4-
Buildil1l! Otlicial
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
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
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
DATE
j/~-
/6' '/07 ~1A~o.1
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
...er1!iNAL
o SITE INSPECTION
COMMENTS:
,(J , /
;e,ec.31 de
nilE
SCHEDULED
CONTR.
PERMIT NO.
tf?- 77'S-
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/? / /
LL;~//ere.
---.---,-=---- ..- )
-----. -.....- . '
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/' '/YaS-e- h k- ~
,-- -
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~ Owner/Contr:
r
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
1NSIiO"