HomeMy WebLinkAboutBldg Permit 04-0468
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3 Yellow Applicant
Date Rec' d
jt ( yO' 04-
PERMIT NO. 04- . o4-f/iJ
(Please type or print and sign at bottom)
I ADDRESS
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BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
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OWNER
(Name)
(Address)
ZONING (office use)
(Phone) 9'$2.. ^ YV7 ,.., 017.r
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BUILDER
(Company Name)
(Contact Name)
(Address) rY' (j ~ /Yla 11 t Ct +v . /.ItA A/
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TYPE OF WORK 0 New Construction o Deck o Porch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace .
OAddition OAlteration o Utility Connection o Misc. VJ,~OO(;) WeLL _ t'j~rt.eSS t..J,,,-,PC ~
CODE: d.R.C. OI.B.C. PROJECT COST/VALUE $. r ~'f7
Typeofd:!stroction: I II III IV V A B (excluding land) l N ~ Dc1It.fI"-...
Occupancy Group: A B E F HIM R S U
Division: I 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.mentlOn~~e"openy and that all constructIOn WIU conform to aU eXISting state and local laws and will proceed In accordance With submitted plans. I am aware that the building
;clal can rev~mlt for J.ust au E errnore, I hereby agree that the City official or a deSignee may enter upon the property to perform needeyJ?il.! Y'
, l Contractor's License No. ;....--1Jate ~
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I Permit Valuation
Permit Fee
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
(Phone)
(Phone)
$
$
$
$
$
$
$
$
I Park Support Fee
I SAC
Water Meter Size 5/8"; 1";
#
#
Pressure Reducer
Sewer/Water Connection Fee
#
Water Tower Fee
#
Builder's Deposit
Other
, TOTAL DUE
This Application Becomes Your Building Permit When Approved
~~
Building Otlicial
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Paid
Date
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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
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CITY OF PRIOR LAKE ~ /. ~J /
INSPECTION NOTICE SCHEDULED ~/V/OJ
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ADDRESS S~h8 ~v~/v' Jl
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OWNER CONTR.
PHONE NO.
PERMIT NO. CJ~ - ~6;Y
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[] FOOTING [] PLUMBING RI 0 EXIGRADIFILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
[] FRAMING [] WATER HOOKUP [] FIREPLACE RI
~ ~SULA TION [] SEWER HOOKUP [] FIREPLACE FINAL
~~NAL 0 PLUMBING FINAL [] GASLINE AIR TST
[] SITE INSPECTION [] MECH FINAL., / []
COMMENTS: ~/ess ~:z.cid'-<..J
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kRK SATISFACTORY, PROCEE';-
[] 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.,
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &I SAFETYI
INSNDTl