HomeMy WebLinkAboutBldg Permit 05-0246
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
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(Please type or print and sign at bottom)
ADDRESS
I. White File I PERMIT A,,6 J
2. Pink City NO. ()j~ ~ 0 z.. 7 '
3 Yellow Applicant
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LEGAL DESCRIPTION (office use only)
LOT~'BLOCK S- ADDITION ~~f(ll/l/J IJ~
ZONING (office use)
F4
PID ZJ-: Z/~ O~, d
OWNER '
(Name)
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(Phone0/dj7021- '$ 7~)
(Address)
BUILDER /Y] ~ 1.. r- /2.0__.
(Company Name) I / ~I /v' ((:J........., - ~.e-r ......<O? ~ '" r l./'-"
(Contact Name) f':h,,,......., f/V'Ci1 .e61'~~fc>-
(Address) 4').,.16 ~ ~ f"eA / A-I/l' .tV &aI'~,A/
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(PhOneU6'" ~ )5'6t7 -@/ L" (
(Phone)
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TYPE OF WORK D New Construction ODeck OPorch ~e-Roofing ORe-Siding
OAddition OAlteration OUtility Conne(tion 0 Misc.
OLower Level Finish
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group:
Division:
B
S U
PROJECT COST IV ALUE
(excluding land)
I
E
II
F
I
III IV
H I
2 3
V
M
4
A
R
5
A
B
>.ro/~, J
o Fireplace
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2.
I hereby eertity that I have furnished information on this application which is to the best of my knowledge true and correct. I also certity that I am the owner or authonzed agent for the
abo ".~pnt ned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
, !Cial can revo s ~ for Just cause Fmthermore, I hereby agree that the city officd~a~66Y ;iu7' the property to perform needed m~.A- .k ..f'"'
Signature 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 $
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
This Application Becomes Your Building Permit When Approved
Paid ~&. ()O
Date ~ . ~ cJJ
Buildlllg Otlicial
Date
$
$
$
$
$
$
$
$
$ 710.00
Receipt No. ~ff}O
By ~~
-
ThiS IS to eertity 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 constllutes 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 1M fK
INSPECTION NOTICE SCHEDULED
ADDRESS .1!:J./.p1'o C()~/
OWNER CONTR.
PHONE NO. PERMIT NO. S"'~ '-~ ~
o FOOTING o PLUMBING RI o EXIGRAD/FILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
~INAL ~ o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPEC ION o MECH FINAL 0
COMMENTS:
N" ~C Ac:.q>>..
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~K SATISFACTORY, PROCEED
o CORRECT ON AND PROCEED
WO K LL FOR REINSPECTION BEFORE COVERING
Inspector
Owner/Contr:
7. 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl