HomeMy WebLinkAboutBldg Permit 05-0258
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
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White File I PER -,;/
Pink City MIT NO. AS-: 0 '2-::>>
Yellow Applicant (/ -
(Please type or print and si~ at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(N ame)
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(Phone)
(Address)
ZONING (office use)
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PID 2~ ()9(P. 0'22-_ /
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BUILDER ~ , /" /J /f
(Company NametP V';'I.;'- PIt.~ ~ &-, (Phone)
(Contact Name) p..4vlyd~.,e.r"~ / (Phr)
(Address) -rOg-~ 4~,,- /'J",&-- ~..,.-<f //(;, _ -t.!~-f-d"/(;?
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TYPE OF WORK 0 New Construction ODeck OPorch r\(~e-ROofing ORe-Siding OLower Level Finish
DAddition OAlteration OUtility ConnC;n 0 Misc.
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
pr."L-Y6'/.S'/r ~
~LL.~rd/-fd1/'Y:
o Fireplace
B
S U
PROJECT COST IV ALUE $
(excluding land)
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
fhrmshed mformation on this application which is to the best of my knowledge tme and correct. I also certify that I am the owner or authonzed agent for the
io II conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
rmore, I hereby agree that the City official or a designee may enter upon the property to perform needed mspecl1ons.
x
Signature
Contractor's License No.
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
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 7(;. vU
Date ~-, /. "r
Buildlllg OHicial
Date
~-7-t9.r-
.. - Date
# $
# $
$
$
# $
# $
$
$
$ 1(p.(//)
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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 requested. ThIS document
when signed by the City Planner constitutes a temporary Certificate of Zoning 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
ADDRESS lLol D 11 ~~l
OWNER CONTR.
PHONE NO. PERMIT NO. 4- 26~
o FOOTING o PLUMBING RI o EXIGRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL 9 U~TS~
o SITE INSPECTION o MECH FINAL
COMMENTS:
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~ORK SATISFACTORY, PROCEED
CORRE '" liON AND PROCEED
, 0 C Rr K, CALL FOR REINSPECTION BEFORE COVERING
Inspectc ,r: /J Owner/Contr:
CALL 9~OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD';~IREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~ - INSNOTl