HomeMy WebLinkAboutBldg Permit 01-1106
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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(Please type or print and sign at bottom)
ADDRESS
1. White File
2. Pink City
3. Yellow Applicant
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LEGA~ DESCRIPTION (office use only) f\ .
LOT S BLOCK ~ ADDITION ~..4 La~
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OWNER
(Name)
(Phone)
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
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13 1'- I'k-- AJ,
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(Phone)
(Phone)
P'lP 55Yy/
TYPE OF WORK
;f!-e. Roofing
OAlteration
o New Construction
DDeck
o Porch
OAddition
OLower Level Finish
o Fireplace
o Misc.
PROJECT COST/VALUE (excluding land) $
Date Rec' d
PID
~51-D00
76 J-~Y/-(j30Y
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
~ter upon the property to ~~ed inspections. lor 5"-0 I
- Signature Contractor's License No. Date
Permit Valuation ?~ .0 0
Permit Fee $ 7l/.7r
Plan Check Fee $
State Surcharge $ /.2-r
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
'1(;.00
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Paid
Date
Building Official
Date
# $
# $
$
$
# $
# $
$
$
$ Jf, . 0 ()
ReCe~"'
By
I
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.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
;a:-flNAL
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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DATE
70k.r-
i1~~
TIME
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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~WORKS~TORY.P~
o CORRECT ACTION AND PROCEED
o CORRECT WOR~ ~~':7R REINSPECTION BEFORE COVERING
Inspector: #If - Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
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