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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
~ I ro-!CfO
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
LOT
ADDITION
6. BUILDER
(Name)
(Address)
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
OO~06fZ-
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
ish lication which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
nd t at all construc I '11 nform to all &xisting state and local laws and will proceed in accordance with submitted plans. I am aware that the
Furt e ore, I hereby agree that the city official or a designee may enter upon the property to perform needed il)spections.
I Io/ll>/VD
License No. / Date
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Depth
10. CULVERT SIZE
Yes No
x
16. PROJECT COSTNALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Back
Side
Front
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
USE OF BUILDI~U J.c___
SPACES ON PLAN
PERMIT VALUATION
fI
()OO, OtJ
TYPE OF CONSTRUCTION: I 11 111 IV V
Occupancy Group A B E F HIM
Division 1 2 (JJ 4
Permit Fee................................... $
S U
City:
ry1,'15
'18. SC)
/. 50
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
~
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This A~es Yo~r Building Permit When Approved.
By i:J~/-J Date "/~lloo
Certificate of Occupancy
Issued
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Paid
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may procee as requested. This document when
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
City Planner
Date
24 hour notice for all inspections (952) 447-9850
Special Conditions rr any
OO~05(~
White - Building
Canary - Engineering
Pink - Planning
Tht" Ct'nlt'r of Ihe Lake- Countr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT :J<(')O~ ~C~ blQ....
APPLICATION RECEIVED \.l~ \ Co ~ \ /)fJ757)
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~('(jo ~ A)E
Accepted With Corrections X
/44'lQ
bl'Wlli f\~A 1 t..
Accepted
Denied
Reviewed By: &J.1/t re-II:)! Date: ~I Z / / O()
Comments: ~e-~o DEc..J~ HA..ND -~u..T ~N"O A:LL-
THe- I~FO~M..^,T(o~ o,..l Tt-\6 ~~tI~
\)L~N"S .
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
OO~05/7--
White - Building
Canary - Engineering
Pink - Planning
Th(" Cf'nlt"r of Ihe t..ke Counlr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~()~ ~ U\o..1 b\.tJ
APPLICATION RECEIVED J~ \ Co '"' 1 <90150
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/'ILf'19 N ifFiryk- CArc~ NE
Accepted
Accepted With Corrections
Denied
@;
Date:
Reviewed By:
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
..
"
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS /'-Il/? 1 It/I~f(r /NGAL-€ C/tZt!-LE jiG.
TYPE OF WORK tI ~ W ,7)E:C-JL
USE OF BUILDING ~ES. A/t2,
PERMIT NO" 00, O~/ L DATE ISSUED fa I z/ /(){)
BUILDER ROD~E'( ScHAIBLE: #- 'SZ-233-0i'"38'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
. , INSPECTOR DATE
I FOOTING ~/t I '-?r. I r,t;N'/tn
~NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~. I I
I FINAL I,)C LPh ~~/lpi
Call between 8:00 and 9:00 A.M. for all j-- pectlons
FOR ALL INSPECTIONS 447-9850
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