HomeMy WebLinkAboutBldg Permit 01-1010
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and siltll at bottom)
ADDRESS
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l. White File
2. Pink City
3 . Yellow Applicant
(I~A-/ fbI
LEGAL DESCRIPTION (office use only) ·
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LOT BLOCKJ.Lf ADDITION~..?1tt1_. '::4.~ c{}~1..L-
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OWNER
(Name)
L -e. e.-
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
PJD;;25- [=3~- Oll-J
(Phone) I" I ;). - qq 0- 5 j f.c /0
(Phone)
(Phone)
o New Construction
o Deck
o Fireplace
OPorch
~e-ROOfing
DAlteration
ORe-Siding
DUtility 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 proP/ perform needed inspections.
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Signature
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
DLower Level Finish
DAddition
PROJECTCOST/VALUE (excluding land) $
Contractor's License No.
$
$
$
$
$
$
$
$
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
Other
TOTAL DUE
'-;l{, 7 ~
! <;J. C;
This Application Becomes Your Building Permit When Approved
I Paid
I Date
,
7~ ,0 u
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Building Official
Date
#
#
#
#
,7/701
Date
$
$
$
$
$
$
$
$
$ ~G>.ex)
Receipt No. Llot:J/1
By (f/
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 NOTICE
SCHEDULED
ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
DATE TIME
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'1/30
'I-I/) I!J
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
fr: 0 )NSULA TION 0 SEWER HOOKUP
')!f FINAL 0 PLUMBING FINAL
. 0 SITE INSPECTION 0 ~ FINAL
COMMENTS: fe --fl96'T, f
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IV e..a.t\.. -e. GII\ 1 0 u.r-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK,\CALL FOR REINSPECTION BEFORE COVERING
Inspecto$ --\~ Owner/Contr:
CALL 447-9850 FOR TJ NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl