HomeMy WebLinkAboutBldg Permit 04-0886
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please t}'1Je or print and sicn at bottom)
ADDRESS
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Date Rec' d
9. i ~4-
I. White File I PERMIT NO
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Sf-
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
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OWNER
(Name)
Woyn,-
(.,/ t.l dJ <)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
ZONING (office use)
PID 20'. ooa. on. 0
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(Phone) 'I CO - ., 9 'I:J-
(Phone)
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TYPE OF WORK 0 New Construction ODeck o Porch ORe-Rooting ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection 0 Misc.
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
B
S U
PROJECT COST IV ALUE $
(excluding land)
II
F
I
mIVVA
HIM R
2 3 4 5
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 ca"):1e t 's ermit for just cause. Furthermore. I hereby agree that the city official or a des?!:1.(jma,,;J; 3jhe7P?0 perform neede~7107 0 'I
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 Park Support Fee
I SAC
I 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 Pennit When Approved
I Paid
I Date
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II.., I.. P 1-
Building Ollicial
Date
# $
# $
$
$
# $
# $
$
$
$ ? ,. 0 ()
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ReToo 4'771e-
By,.,....
()
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 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
INSPECTION NOTICE
SCHEDULED
ADDRESS
f/~s- ~~o ~
OWNER
PHONE NO.
o FOOTING
a FOUNDATION
o FRAMING
o INSULATION
....en:iNAL
o SITE INSPECTION
COMMENTS:
CONTR.
PERMIT NO.
o PLUMBING RI
a MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
DATE TIME
3~~-
,
&/~W6
o EXIGRADlFILLlNG
a COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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ORK SATISFACTORY, ro'r(Ul.#ccD
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL fO EINSPECTION BEFORE COVERING
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Inspector:
Owner/Contr:
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CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
IIISNOTl