HomeMy WebLinkAboutBldg Permit 05-0726
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
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Pink
Yellow
Date Rec' d
File
City
Applicant
I PERMIT NO.#~ -70-6 I
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LEGAL DESCRIPTION (office use only)
LOT it? BLOCK 3 ADDITION
OWNER
(Name)
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(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
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ZONING (office use)
PID ;?5""d. Of ~
PROJECT COST/VALUE $
(excluding land)
(0 I;) I ?JUJ. O.~ 'I "3
-3 )d. 'Y'-ll. tvu J
,
( \ l ,
~ ;'/1..( I JVt-;i) ~ 3 '17
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
Paid
Date
/ ------
-/ LR /~ _____
I ~ 8--~"" ::J
L-, (2, e n-w h',,- '- t f~~"1 (Phone)
, () \ S (?~"-lr-, ~ J (Phone)
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TYPE OF WORK 0 New Construction ODeck OPorch ~'Re-ROOfing ORe-Siding OLower Level Finish
OAddition OAlteration OUtility conne~n
CODE: OI.R.C. OI.B.C. 0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
(Phone)
o Fireplace
I hereby certify that I have furnIsh d mfllfmation 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-mentIOned Pro~lty an tha II constluctlOn Will conform to all eXlstmg state and local laws and Will proceed m accOldance WIth submllted plans I am aware that the bUlldmg
offiClal can revoke thIS I mil 1'0 us ISe Flllthel more, I hereby agree that the City offiClal or a deSIgnee may enter upon the propelty to pel form needed mspectlons
X '- ~ Signature" . ;} 0 3'~~t~c~r~LtCense No ~)
Permit Valuation
Permit Fee
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$ /t(, 1es- I
$
$ j rl~5
$
$
$
$
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
8ltildll1~ Ofticial
Date
#
#
#
#
$
$
$
$
$
$
$
$
$
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Receipt No. Lf Lf' I ~ I
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By
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 temporary Certificate of Zonmg compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
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
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
, .. ;..,oS-
ADDRESS
L'7;(,(~
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PHONE NO.
PERMIT NO.
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OWNER
CONTR.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS: f'~rl>>r ~ /
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND P CEED
o CORRECT WOR CAL REINSPECTION BEFORE COVERING
Inspector: I
LI
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
/NSItOTl