HomeMy WebLinkAboutBldg Permit 05-0759
(Please type or print and sign at bottom)
ADDRESS
/S02Z
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1 White
Pink
3 Yellow
File
City
Applicant
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BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
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OWNER
(Name)
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(Address)
BUILDER lJ _ .
(Company Name)~
(Contact Name)
(Address)
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(Phone)
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(Phone)
(Phone)
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I PERMIT NO. (J.s. () 7.59 I
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ZONING (office use)
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TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition DAlteration DUtility Connection
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
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o Mise.
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III IV
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2 3
A
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B
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PROJECT COST IV ALUE $
(excluding land)
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I hereby certify that I have hlrnished in(()fmation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above-mentIOned property and that all construction will conform to all eXlsung state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg
:ficlal can reViumli Just ca) Fl11thel~ that the City offiCial or a deSignee may enter upon the propelty to perform nt8e~Wec:~ ~
Eatur /' Contractor's Ltcense No - Date
A
VI
Park Support Fee
$
$
$
$
$
$
$
$
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
Paid
Date
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Builctll1g Official
Date
#
$
$
$
$
$
$
$
$
$
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#
#
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Receiot)Jo.
By.A
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ThIS IS to certify that the request in the above applicauon 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 temporaty Certificate of Zoning comphance and allows construction to commence. Before occupancy, a Ceruticate of Occupancy must be
lssued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
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ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
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o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o M~. FINAL (J
~~/COr
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
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WORK EED
o CORRECT ACTION AND PROCEED
o CORRECT WORK;. C~'7:rEINSPECTION BEFORE COVERING
Inspector: ~ /' Owner/Contr:
II" ,;
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &I SAFETY!
INSIIOTl