HomeMy WebLinkAboutBldg Permit 01-0574
(Please type or print and sign at bottom)
ADDRESS
'1/30
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I. White File
2. Pink City
3. Ye!low Applicant
/LfO t^ _< f- A./~
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
AJZ-It-r-- ;;;-3
OWNER
(Name)
DtVJ
(Address)
1(1 C0mfYJ
(Phone)
S ",../iJhltlso}J (----ONS+r-
(Contact Name) $+~rr
fyCJK 333 s+, Idwy d-32?
BUILDER
(Name)
(Address)
TYPE OF WORK
o Misc.
PI~S- <1d3- 006-~
t!-J1 fJ ~
3UJ-Lfq~-F"~ol
(Phone)
(Phone)
IJ f)!:a!a- m tJ ,5'b,3g<f
I
o New Construction
o Deck
~-Roofing
ORe-Siding
OUtility Connection
1 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 th~at the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon,tJj!.!r:trrnto per~ n ded inspections. I
X ~ 7 ,II/}. JotJl
\ """ 19nature Contractor's License No. I 'Date
I
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
o Porch
OAddition
OAlteration
OLower Level Finish
o Fireplace
PROJECT COST /V ALUE (excluding land) $
Park Support Fee
$
$
$
$
$
$
$
$
SAC
Water Meter
Size 5/8"; 1";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
--10 .00
t -ll-D I
This Application Becomes Your Building Permit When Approved
I Paid
I Date
Building Official
Date
#
#
#
#
$
$
$
$
$
$
$
$
$
___ ,~. r ['./
Receipt No. ~ -, (p 'i ()
r/
By
This is to certify that the request io the above application and accompanyiog documents is io accordance with the City Zoniog Ordioance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoniog compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
..-.--r-.-----... -
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY O:"-1"'RIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
4/.:30 /4tJ -& ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
~ 0 INSULATION
~, ~ FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
f', I').~ p ..\-~ I p
DATE TIME
0'/'1.0 I A.T.
0(. () 57"'1
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~ GASLlNE AIR TST
I '\ ~7Jr=
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREC7~A'L FOR REINSPECTION BEFORE COVERING
Inspector: 'P \t.LAJtt Owner/Contr:
CALL 447-9850 FOR THE N~T INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl
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