HomeMy WebLinkAboutBldg Permit 01-0962
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
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FI've Hqul /cs
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name)
GICf(M
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
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Acofl m
g
TYPE OF WORK
o Misc.
o New Construction
DLower Level Finish
I. White File
2. Pink City
3. Yellow Applicant
Rei
(Phone)
(Phone)
(Phone)
o Deck
~-ROOfing
DAlteration
o Porch
o Fireplace
DAddition
Date Rec' d
'1-5 -0/
I PERMIT NO. OI-09t,Z, I
ZONING (office use)
PIDZ5-/aJ-OI&- /
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
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-- Signature Contractor's License No. Date "
I Permit Valuation
I 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
PROJECT COST IV ALUE (excluding land) $
2-/500.00
$ 7~ 75'"
$
$ /. ~,;
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
W>>f
Building Official
q. .~lol
Date
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
I Builder's Deposit
I Other
I TOTAL DUE
I Paid 'i~. f/V
I Date t/ 1('" IJ I
.
# $
# $
$
$
# $
# $
$
$
$ /(;.0 ()
Receiptd,W 4053G
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
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/;:,1/79 hl 14~/5
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
/J 0 MECH FI~L
/Le/tJ~ r
COMMENTS:
.// /)
/Loo (
TIME
01- 962
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
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~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~O~K~C:J-YOR REINSPECTION BEFORE COVERING
Inspector: yar- Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH & SAFETY!
INSliOTl