HomeMy WebLinkAboutBldg Permit 05-0316
(Please type or print and sign at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
f.2-0,05
I. White File
2 Pink City
3 Yellow Applicant
I PERMIT NO. {;5e{)~"/0
/1877 /5e:rJa# s;:r,
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION tJt#17Z1/l/~ $ CJ11!.H
PID 25. 0 Z 8. 0 I Z. 0 .
OWNER
(Name)
(Y\lC~\.- <( \)-e-~~
qf11 ~ ~r M
(Phone)
(Address)
,~~
PL-
BUILDER 11 -:7." A NO, ,,J)~
(Company Name) (,()b/;~Vff:. vi, ~ ~f11 OlJe2A,....-L'f (Phone)
(Contact Name) tvl(C~~1..- ~J JZ1~ SWJdlt:>o!L.(Phone)
(Address) ?'I/O h4-IUVtUC' I5L-Vf} ) u+~JiuC ~7J4tf
- I
o New Construction o Deck o Porch 'rstRe-Roofing MRe-Siding
DAddition DAlteration DUtility Conne~ 0 Miscl '
TYPE OF WORK
CODE: DI.R.C. DI.B.c.
Type of Constnlction:
Occupancy Group: A B
Division:
ZONING (office use)
"e /"U)
lDl2 - 3~ 7- 30$'5
DLower Level Finish
I
E
III IV VA
HIM R
2 3 4 5
B
S U
PROJECT COST IV ALUE $
(excluding land)
o Fireplace
J (., s-; !!l!2J.~
I hereby certify that I have hlrnished mformation 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 operry and t all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
:ficial can revo lJ.Is IJ rml~ Furthermore, I hereby agree that the Clry offiCIal or a deSIgnee may enter upon the property to perform needed m:j:IZO_ O~
SIgnature c:::=...... \. Contractor's LIcense No. 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
7 nit;. U)
I
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
#
#
Builder's Deposit
Other
TOTAL DUE
$
$
$
$
$
$
$
$
$
1~-_vO
This Application Becomes Your Building Pennit When Approved
Paid
Date
'7(./ t,V
</. Z j->t/J ~
I Receip~~q" /I 91 J {l
I By f'!//
Building Ollicial
Date
ThiS IS 10 certify that the request in the above applicatIOn and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requcstede ThIS document
when signed by the City Planner consutlllcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Ceruficate of Occupancy must be
isslled
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
ADDRESS
q~77
rScv/A Sri--
OWNER
CONTR.
PHONE NO.
PERMIT NO.
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
rr- ro/ / <:irk
l
COMMENTS:
~.~
/' / J!y _
~ L~ V~
"-----
DATE TIME
/Y2I1 q
..s- VG
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
---..... --......
~r'/ '\
r LL )
/
~
,/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOY"f~~R REINSPECTION BEFORE COVERING
Inspector: 1/ lY Owner/Contr:
, I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
1JfSNQT/
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!