HomeMy WebLinkAboutBldg Permit 01-1028
(Please type or vrint and sign at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File I PERMIT NO
2. Pink City . .A
3. Yellow Applicant V
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LEGAL DESCRIPTION (office use only)
LOT Z BLOCK 5 ADDITION 5/17//.0 ~T 3eP
OWNER
(Name)
(Address)
(Phone)
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BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o Misc.
o New Construction
OLower Level Finish
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(Phone)
O~/hone)
o Deck
DPorch
ORe-Roofing
OAlteration
o Fireplace
OAddition
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jJ(;Re.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 property to perform needed inspections.
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I Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
PROJECT COST IV ALUE (excluding land) $
Signature
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I $
1 $ I- 2-~
I $
1$
I $
I $
1$
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Building Official Date
Contractor's License No.
Park Support Fee
SAC
Water Meter Size 5/8"; 1";
I Pressure Reducer
I Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
I TOTAL DUE
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Paid
Date
Date
# $
# $
$
$
# $
# $
$
$
$ 7f,.t>O
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I 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 I
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 PI~OR LAKE
INSPECTION NOTICE
DATE TIME
ADDRESS
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SCHEDULED
OWNER
CONTR.
PHONE NO.
PERMIT NO.
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o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
k 0 INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
~ FINAL 0 PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION 0 MECH FINAL 0
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK,~ALL FOR REINSPECTION BEFORE COVERING
Inspector: ~~ I Owner/Contr:
CALL 447-9850 FOR TH =: NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/NSNOfl