HomeMy WebLinkAboutBldg Permit 01-1183
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPOR.)~Y CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
"~95 ~6f;F~
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LEGAL DESCRIPTION (office use onl~
l) cfE /()/ tJl, 1
LOt BLOCK ADDIOON
OWNER
(Name)
(Address)
I. White File
2. Pink City
3. Yellow Applicant
Date Rec'd
IO~ ~Z--'O I
PERMIT NO.
0/-//83
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!
(to IJ~ PID 25-//(,- 067-/
(Phone)
ZONING (office use)
,c/J D
(Phone) b/') - 91~- t?'1uY'
(Phone)
o Porch
,I
~e-ROOfing
OAlteration
(Na~~~ t" ,?Nl'~(f
(Contact Name) ;:f~
ss) 3:t.,Jf!~1 ~~ ~~~'1
TYPE OF WORK 0 New Construction ODeck
o Misc.
OLower Level Finish 0 Fireplace
OAddition
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 property to perform needed inspections.
x
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
~/500.00
$ 74-. 7~
$
$ /. z..-s-
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
fAj4j
Building Official
-
/0. ]'2~O I
Date
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
I Other
I TOTAL DUE
I Paid
I Date
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/1. t...,:1..--1'1",
#
#
#
#
---
$
$
$
$
$
$
$
$
$ '1 (p .0 0
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Receip)fij'f H7s L
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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
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CITY OF PRIOR LAKE
INSPECTION NOT{CE
SCHEDULED
ADDRESS
!rJt{GfS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATIOKBJ
o FRAMING
o INSULATION
FINAL
~ SITE INSPECTIO
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP ,
o PLUMBING FINAI/,/
o MECH FINAL //
COMMENTS: 4 I
/
DATE TIME
AiT",
1)/ ~ /(~3
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
ft!WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~:. CALL FOR REINSPECTION BEFORE COVERING
Inspector: / Owner/Contr:
-....-j
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
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