HomeMy WebLinkAboutBldg Permit 01-0711
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3 . Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
\40'dS ~~~ef'S <(r J ~rlO( lcL~e, M~ S~~'i1'),
LEGAL DESCRlt'uON (office use only) ~
LOT q BLOCK ! ADDITION ~('HAII.L/Jl.A
OWNER \
(Name)~ :'1o.'oP,"" \n('\~\^
(Address) lL\o")< f2..v*-aotb~ <It) 0'1.1]1 L'L~ Mf\} ~S~'\?
BUILDER () ()
(Name)-1,\_~t \A)M VJJ~'^~
(Contact Name) S(\{)-H-- \l-O.Vt7~
(Address) \L\O'O'D 'l-?:/6 ~ ~) V\~N\00..\V\, \M.~ S544-t"J
TYPE OF WORK
o Misc.
Date Rec' d
ZONING (office use)
~I
PIDdS" I1L!- ()(f1 ~
(Phone) ~L- 4UO- d~ I
(Phone) ~~~-SS'1-<6Io'1<6
(Phone) ':P MP
o New Construction
'fJRe-ROOfing
OAlteration
ORe-Siding
OUtility Connection
OLower Level Finish
o Fireplace
OAddition
PROJECTCOST/VALUE (excluding land) $ ~)
$ jLf,. /.~
$
$ ) ~~S
$
$
$
$
$
I Park Support Fee
I SAC
I Water Meter Size 5/8"; 1";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
Other
ODeck
o Porch
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 ail 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 ul)n the jfoperty to perform needed inspections.
X t/-, fj~llJ.L ?>~ r'\1'~\ol
Signature Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid I (tJ . OU
Date ~- 13- 0 I
I
Building Official
Date
# $
# $
$
$
# $
# $
$
$
$ 1~;d)
Receipt No. f.jO J a:i)
By ~/
U-
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
CITY OF PRIOR LAKE
INSPECTION f{CrrICE
SCHEDULED
DATE TIME
?JZS/t>/ II/iS
ADDRESS I-~ () 2-5""
R~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
0(- 7/1
o FOOTING
o FOUNDATION
o FRAMING <<l\
o INSULATION ~
1Zl7FINAL
I[i SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
-"I'b;-';'.i"
"WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~ALL FOR REINSPECTION BEFORE COVERING
Inspector: ( ~ Owner/Contr:
J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTJ