HomeMy WebLinkAboutBldg Permit 05-0503
(Please type or print and si~n at bottom)
ADDRESS
IfR8{g~
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White File
Pink City
3 Yellow Applicant
Date Rec' d
5.3/.0S
PERMIT NO. C;S-. 0503
1"(/1 vl/O W
sw
?-N
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
PID 25"'. z-+t3. 03.1.0
OWNER
(Name)
Got3
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
~bl
-~
r
/0 z '2--
-:s- u NlS.4 U
(Phone)
, - - , /
(2,It/vCr I- tt~~~/,~
. /7 ./
c e-L r:;-O e rJ
.Pf e:AP trN
ZONING (office use)
.e.r
1'52- 'i!JO -g~
. -
(Phone) (/,1 }.--r/7S'= 7 '7 'I 7
(Phone) 7 $"2 .- SlI(,~ '-2' 772
(1 (O;i(V~ I .I'{~ '~7L ~2- -
s.~
TYPE OF WORK 0 New Construction ODeck OPorch ~e-Roofing
OAddition OAlteration OUtility ConnGn
o Misc.
CODE: OLR.C. OLB.C.
Type of Construction:
Occupancy Group:
Division:
A
ORe-Siding OLower Level Finish
B
I
E
PROJECT COST IV ALUE $
(excluding land)
o Fireplace
-s;~ ~~
I hereby certify that I have furnished mf()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-mentlOned property and that all construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
~ftCial can re~~urthJermore, I hereby agree that the City OffiC2'O '1g~aY ~t~he propel1y to perform ne?f::;/~_>
"" - Signature Contractor-;s LicenseNo. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
II
F
I
III IV
H I
2 3
V
M
4
A
R
5
B
S U
$
$
$
$
$
$
$
$
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
'711 ATY
~. '3' .0'--
Receipt No. ff.?.f 0
By ~_
;*'r -c _
l3uildlllg OIlieial
Date
$
$
$
$
$
$
$
$
$ 7(,-f}tJ
ThiS IS to certify that the request in the above application and accompanymg documents is in accordance with the City loning Ordinance and may proceed as requested. Thts document
when signed by the City Planner constItutes a temporary Certificate of loning compliance and allows constructIOn to commence. Before occupancy, a Ceruficate 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
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED C'~
ADDRESS ~f(fh lA/II (fhA/ ~
OWNER CONTR.
PHONE NO. PERMIT NO. S-- S7J ~
o FOOTING o PLUMBING RI o EXIGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE R1
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
-----
~ / r_
/ L/l frs.t
(
'--
y,<- ... rtXJp-
~
r1 )
/'
~
-
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~~K,;"R REINSPECTION BEFORE COVERING
Inspector: I/' V r Owner/Contr:
,
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
_OTI