HomeMy WebLinkAboutBldg Permit 04-0294
(Please type or print and sixn at bottom)
. ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
\. While File I PERMIT NO. ()tf~
2. Pink City
3 Yellow Applicant
f~lalJd IJ/e>>-J ect- ~~~fficeuse)
/5'fL/9
LEGAL DESCR..u-uON (office use only) f}."
Lo4 BLOCK I ADDITION ~ cL
OWNER
(Name)
_~/ ~~~~;?.d~
(Address)
()~
PIDdS- ()5.f"'006 ..()
(Phone)
?S-...;2 -.y?/ - ;;S--~~
BUILDER A ' / /? /? ~
(Company Name)..2A-".....- /~/ ~ IP dI / ;(,yp{ Ci1'
(Contact Name) ~J1II!!? pi' ,~. '.=> r~.;::?..f d ~
(Address) ~p y-~ ~//h",- ~~ ~ _~
(Phone) 9'~.:r:-1/~/-~/u-.<..
(Phone)~L.2~/- S"d~9'"
TYPE OF WORK 0 New Construction DDeck DPorch Me-Roofing ORe-Siding OLower Level Finish 0 Fireplace
o Addition o Alteration DUtility Conne~ 0 Misc.
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
II1IVVA
HIM R
2 3 4 5
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
B
S U
PROJECT COST /V ALUE $
(excluding land)
lication which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
onforrn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ore, I hereby agree that the city official or a designee may enter upon the property to perform needed Inspections.
Signature
,::)5iJtJ ~ I
$ -1tj,tO I
$ I
$ I.,~~ I
$ I
$ I
$ I
$ I
$ I
This Application Becomes Your Building Permit When Approved
Buildin~ Otlicial
Date
p~do:;?S(-r-/
Contractor's License No.
ij-/ 9"-~~
. Date /
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$ 1ft, .---
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
Other
#
#
TOTAL DUE
I Paid
I Date
- .....-
-lb. '
q~/q- 4
,
Recewt No.H&v/ /1 h
By ~ . .
U\
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
r:;;-
TIlle
ADDRESS J5"e tft J;: ~,,~}
OWNER CONTR.
PHONE NO.
PERMIT NO.
4. Zq4-
o FOOTING
o FOUNDATION
o FRAMING
o INSULA~~ ~
~INAL ~
o SITE IN...PECnON
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~ J\ct;.a"!t:)
~(osl ~ p,.-p
. . ."
"-WORK SATISFACTORY, PROCEED
o CORRECT A TION D PROCEED
L FOR REINSPECTION BEFORE COVERING
Inspecto:
Owner/Contr:
-9 50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IN$NOn