HomeMy WebLinkAboutBldg Permit 05-0470
(Please type or print and si~ at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
White
Pink
Yellow
File
City
Applicant
1../16 ct-
,
iL/~~q
rt
/fJ~ (
Date Rec' d
I PERMIT NO. t11i -1/7 ()
ZONING (office use)
PUSIJ
LEGAL DESCRIPTION (office use only)
LOT6BLOCK;;Z ADDlTIONj//H!?nd0t9-n<j 07L ~ ~ YID~3t:. .OO?
OWNER 0
(Name) l'\ F ~-E:-);
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
15 Yl?tJ t-
(Phone)
(Phone)
(Phone)
q~:~-Y40-01~
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing ~e-Siding OLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection ^
CODE: DI.R.c. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
III IV V
HIM
234
o Misc.
A
R
5
B
S U
PROJECT COST IV ALUE
(excluding land)
$ ;;(Stx),-
I hereby certifY that I have furnished mformation on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authonzed 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 buildmg
:fiClaI c~e =mlt for Just cause Flllthelmore, I heleby agree that the City offiCial or a deSIgnee may enter upon the property to perform needed I~~~ ) D.S
F<1' ~ Contractor's License No. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
II
F
1
;;l5'tJo,-
$ -Jt/'" 'it:;;'
$ '// ,,),~
$
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Oflicial
Date
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
Paid "7c,.-'
Date . ~- .;I,e} ~
# $
# $
$
$
# $
# $
$
$
$ /h ,05'
Receipt No/rJ/j5
By ~
ThIS IS to certify that the request in the above apphcal10n and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. 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
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
DATE TIME
CITY OF PRIOR LAKE r,) -o/as--
INSPECTION NOTICE SCHEDULED
ADDRESS ~ uJ:~<;r.4/
OWNER CONTR.
PHONE NO. PERMIT NO. ~--Lt1D
o FOOTING o PLUMBING RI o EXlGRAD/FILUNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULA TIONe:t o SEWER HOOKUP o FIREPLACE FINAL
.B"FINAL <;: ';;r o PLUMBING FINAL o GASUNE AIR TST
o SITE INSPECTIO o MECH FINAL 0
COMMENTS:
u\(
~
cl~
(\ () (
~\~ ~\.. \ I
J -'-.
.,/
~K SATISFACTORY, PROCEED
o CORREC CTIO D PROCEED
o COR CT WO ,C LL FOR REINSPECTION BEFORE COVERING
Inspe or: /~ Owner/Contr:
fAU ~s!:.-o..fHE NEXT INSPECTION 2' HOURS IN ADVANCE.
~t.glfiiEMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl