HomeMy WebLinkAboutBldg Permit 01-0355
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
J. Yellow Applicant
(Please type or print and siltD at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT IJ1BLOCK
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ADDITION
OWNER
(Name)
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, lc> 03?;> f\.l Or-thu.xJod
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(Phone)
(Address)
~
BUILDER
(Name)
(Phone)
(Phone)
---:---
" I Ovdl1 Y'..
(Contact Name)
(Address)
TYPE OF WORK
~-ROOfing
OAlteration
o New Construction
ODeck
o Porch
OAddition
OLower Level Finish
o Fireplace
DMisc.
PROJECT COST /V ALUE (excluding land) $
Date Rec' d
ZONING (office use)
~ ISD
PID J5'-I'II-OCJI- I
4<.11- 5lf~ 7
4q ~- B gL(;1.
ORe-Siding
OUtility Connection
I hereby certify that I have furnished information 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 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 official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
:ter upon the prope to perform needed~ 310 J a 51 7 ~ YI2J 5/0L
Signature '-. Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
Sewer/Water Connection Fee
$ '71/- IJfS-
$
$ ) ~S-
$
$
$
$
$
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
Paid r""} G::> ,OU
Date 4-;),,4 -0.1
Building Official
Date
#
#
#
#
$
$
$
$
$
$
$
$
$
'7t?,--
Receipt No. 30.' ~6qg
rf-/
By
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 Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
DATE TIME
SCHEDULED '-!..,} 5 ~o I 3: 3 0
AJor'tl;~td Rcl-
CITY OF p'RIOR LAKE
INSPECTION NOTICE
ADDRESS
16033
"
OWNER
CONTR.
PHONE NO.
PERMIT NO.
cYl-3SS-
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS;/~~ ~
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- l f/~ ~rtcA. -s-fal1les usel OVl "J~j'-fau
I I
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
}'l WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ .to>>1 Owner/Contr:
CALL 447-9850 Fck THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/NSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI