HomeMy WebLinkAboutBldg Permit 05-0790
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
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Pink
Yellow
File
City
Applicant
PERMIT NO.' ()S ..1iO
(Please type or print and sign at bottom)
ADDRESS
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT /t:;;LOCK?--- ADDITION I <~
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OWNER
(Name) JO r-J
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(Phone)
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(Address)
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BUILDER
(Company Name)
(Contact Name)
(Address) 'i '2,.. ~ (
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TYPE OF WORK 0 New Construction oDeck oPorch ORe. Roofing
L oAddition oAlteration oUtility Connection
O 0 Misc.
CODE: I.R.C. I.B.C.
Type of Construction:
Occupancy Group:
Division:
~e-Siding oLower Level Finish
o Fireplace
A
B
I
E
II
F
I
III IV
H I
2 3
V
M
4
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby ccrtify that I have hlrnished 1Of()rmation 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-mentIone 'operty and that all construction will conform to all existIng state and local laws and will proceed in accordance with submittcd plans. I am aware that the buildmg
:TiCial can n::::[..::::1or ~ ~ hereby agree that the CIty officia;":;~i~~ ~aYle~er upon the propelty to perform need;d ~ns;e;o:', r
Signature Contractor's License No. Date
I Permit Valuation ?~ 5cX>. - I Park Support Fee # $
I Permit Fee $ 14. '1) I SAC # $
I Plan Check Fee $ , . I Water Meter Size 5/8"; I"; $
I State Surcharge $ I. z.~ I Pressure Reducer $
I Penalty $ I Sewer/Water Connection Fee # $
I Plumbing Permit Fee $ Water Tower Fee # $
I Mechanical Permit Fee $ Builder's Deposit $
I Sewer & Water Permit Fee $ Other $
I Gas Fire~ce Permit FJe $ TOTAL DUE $ 70- -
/ / #oIl ,
mg emu ~d I Paid 4 lp..... , ReceiPt No_ ~R 1.3
, ~. I Date ~{ By ru1t{
Dn:;>
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
whcn signcd by the City Planner constllutcs a temporary Certificate of Zon1Og compliance and allows construction to commence. Before occupancy, a CertIficatc of Occupancy must be
issucd
Planning Director
Date
24 hour notiee for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
_LAKE
.~ NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
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DATE TIME
SCHEDULED
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CONTR.
PERMIT NO.
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o PLUMBING RI 0 EXIGRADIFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL 0
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o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WO~, ~~ REINSPECTION BEFORE COVERING
Inspector: ,l/ V Y Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSllOTl