HomeMy WebLinkAboutBldg Permit 01-0928
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. ADDRESS
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Ai: ~n UTILITY CONNECTION PERMIT
1. White File
2. Pink City
3. Yellow Applicant
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S'T
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name) 8 v.~
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
IfF fl J/ /) w
Date Rec' d
PID~S-- t:V3-()/:;-()
(Phone) qf':; - i/~1 - 3 h ~~
(Phone)
(Phone)
o New Construction
ODeck
~e-Roofing
OPorch
OAddition
OAlteration
o Fireplace
OLower Level Finish
o Misc. fI OU s E /.J-# lJ (j..~,1 It , IE.
PROJECT COST IV ALUE (excluding land) $
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 upon the pro;7;0 perform needed inspections.
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I' 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
$ -}I/" '75
$
$ t t?Lt)
$
$
$
$
$
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
I Other
I TOTAL DUE
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This Application Becomes Your Building Permit When Approved
I Paid
I Date
Building Official
Date
# $
# $
$
$
# $
# $
$
$
$ "/~~OU
. I r
Receipt No. 'fO 5"V<-f
By /ilC-- ""
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
DATE TIME
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o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
(A!~./\
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
~ ?RY'
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: ~
-
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,
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fI WORK SATISFACTORY, PROCEED
Ie; CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ <. Owner/Contr:
CALL.. 447-985~ F~J THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl