HomeMy WebLinkAboutBldg Permit 04-0181
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS /fISC)
I ~5 3? rAD1t/l//I1/ \ 7JU
I. White File I PERMIT NO
~. ~~~~w ;::Iicanl . 04 - /? /
16S-fJ'l t/tJ; L!d--'
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION X
PID02 S' - CJ /9 -00 S - d-,
OWNER
(Name) T8-St>V
(Address) Z 76 iJ (
k ME's
tOf-~ c,l~-c1
"
ZONING (office use)
Rtf
).C/.f
(Phone) q ')2". 7t)?;< 70'-1 C;
. . ,
;f/eGv- frec.c,cR /l, 4? ~ c>, /
;
BUILDER
(Company Name) K' A~€ '5 F~ rt-,..Ifl7;'t'St' ~
(Contact Name) 5~oJ./
(Address) "l. 7 6 ~ ( tA "j'h".J.... jo ~
(Phone)
(Phone) tiCl- 75-~ 70 e...r ~
h
TYPE OF WORK 0 New Construction ODeck o Porch p(Re-Roofing 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
PROJECT COST/VALUE $
(excluding land)
I hl'feby 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 authorlzcd agcnt for the
above-mentIOned property and that all constmction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
;cial can revoke this per~ore, I hereby agree that the city 0:; a;si::t m.;en~; t~roperty to perform n~e:;t:ns~ 0 y
~ /' 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
II
F
1
ill IV V A
HIM R
2 3 4 5
B
S U
$
$
$
$
$
$
$
$
/5/. 57J
Park Support Fee
SAC
#
#
.50
Water Meter Size5/S"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
I Paid
I Date
16 d.-- J
";<- 30-0L-1
/
Receipt No.
By r
~
Building Ollicial
Date
$
$
$
$
$ I
$ I
$ I
$ I
$ /~:J..~ I
U~~3~
, -
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 requcsted. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a CCltificate 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
DATE nME
SCHEDULED
...r/2(hs -
I
ADDRESS
/653Y fr~~/";'"
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
[] FRAMING
[] INSULATION
~L
o SITE INSPECTION
COMMENTS:
/1 I)
/Le~r
~
/' /'
( /'/" S~
"'-
CONTR.
PERMIT NO.
&/'" /3'/
o PLUMBING RI
o MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
[] MECH FINAL
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
[] FIREPLACE FINAL
[] GASLlNE AIR TST
o
..........., J /
(' o~4) /e re
/
~----' ---- ~ '
,,--rJ ' )
/-; k ./
.-------
~WORKSATlSFACTORy.PROCEED
[] CORRECT ACTION AND PROCEED
[] CORRECT ~~A /L FOR REINSPECTION BEFORE COVERING
Inspector. /~./ OWnerJContr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH & SAFETY/
_,