HomeMy WebLinkAboutBldg Permit 01-0572
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
I. White File
2. Pink City
3 . Yellow Applicant
OI-:.5-~:2-
PERMIT NO.OI-.$""'1~
/U~q !--V/JJ..! S !l--~
I
LEGAL DESCRIPTION (office use only)
LO~ BLOCK d---ADDITIONP ~~
OWNER
(Name)
e CUnJ (
(Address)
BUILDER
(Name)
LJd{)~
(Phone)
~~
(Phone)
(Phone)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
o New Construction
~e-Roofing
OAlteration
7G (0,",,=)
PID;:)5"-o/~-~-()
L/I/~-bp I
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
enter UPo/~th~ property to perf~:~~r in:pecti/s. II
X I.~~,(/Vt'-L~,,~v~~ ~'-/I-ol
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
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
DDeck
o Fireplace
OPorch
OLower Level Finish
OAddition
PROJECT COST IV ALUE (excluding land) $
$
$
$
$
$
$
$
$
71(, 7,J
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
.....-
I. if,)
This Application Becomes Your Building Permit When Approved
Paid
Date
,
~- I/-C/!
/} 1-, f lr1r
I&'''' ,0.
Building Official
Date
#
#
#
#
$
$
$
$
$
$
$
$
$
?0'~
,,1 .,'
ReceietNo.~7~ '10
By f)S;
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
.........I.~
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
I.c
oJ f1CE
SCHEDULED
.""DRESS
/ (p bJ ft:/r
r1~
- (j
CONTR.
OWNER
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
COMMENTS: ~fJ.J'-~,
DATE TIME
2/stJlf2L /O! 3 c)
7 ,
tJ/- S):l-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
J4 WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
:.::ECT WO~~OR REINS::::::FORE COVE~NG
l.;o J
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!