HomeMy WebLinkAboutBuilding 07-1184
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
I. White File
2. Pink City
3, Yellow Applicant
I PERMIT NO. }- J I S4- I
.
Fi s ~ IO/~..t
ZONING (office use)
/2..J
I ~ 1/6
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER G;tf 0..(' prior- L",Ke.... (r-Cio1/( 80yk
(Name) ,. (Phone)
;;.
(Address) Ltbt.f<o Dc..l<o ~ C' / se
~ of
BUILDER
(Company Name)
(Contact Name)
(Address)
{ r-e ttI ~ /,I{.? /l,'
80 6 ._' c' I. "; .\
!": :.,../
(Phone) (/; (.;). - .) $ 0 - $ ii,
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition ~teration OUtility Connection
CODE: DI.R.C. ~I.B.C. o Misc:
Type of Construction: I II ill IV V A B PROJECT COST/VALUE $-11<'0" .~o
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
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
:ffia;.;:; ;k";J ~ause, Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform ~~:;::ections,
Signature Contractor's License No, I Date
Permit Valuation
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 $
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Your Building Permit When Approved
Paid
Date
Receipt No,
By
jL- Z'-t',
Date
This is to cettify 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
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 4474245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2, Gold City
3 Yellow Applicant
1/ Z- Z/IIJ <7
I PERMIT NO. 07. , l~ I
ZONING (office use)
.-- "
J... ,{ <
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address) Lk.Jl b
(Phone)
f:~\- ~~. (/.J.~
APPLICANT 5
(Name) . \iA/
,
"'\L\~
P \~ "" b t( "Co.
)
1~\.I."'<;1 GJ
, f
(Address)
V~ Se:1 ~
m~
~<./
(Phone) J ~) - rt"\ 1-- tyc?,2 5-
~vc,c'~ ~~ ~s31~
(City) ( (Zip Code)
(Phone) '1 ~)- - ~L( 1 ~ go) ~
DATE --,.... .l.J- - 0 ,
(Address)
(Contact Person)
APPLICANT SIGNATURE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
\. Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
l Sinks ( \~"\-t~ 5': ~\ Backflow Assembly Test
Bar Sink J Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial. Commercial & Multi-family 1% of job cost with a $39,50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
,
Estimated Cost $
Building Permit #
fJ ".J/~
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
(Office Use Only)
This Application Becol}les Your Building Permit When Approved
~~ /Jz,Z-/O~
Building Official / Date
I Paid
Date
I :;,iPt No
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714