HomeMy WebLinkAboutBuilding 05-0979
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DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
() s: 0 97r
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
...--'
o . ()...:>
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
~Sw
12. NO. OF STORIES
LOT
BLOCK
PID 25. Z9S. 030. 0
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
(Name)
..J'OS h
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
VII Jd U..!o 0)
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
J ?~ 2)dv/u oS
sr/7
(Tel. No.)
b/J
J.7-5L/ ~}
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
6. BUILDER
(Name)
(Address)
Fireplace 0
Alterations 0
Septic 0
Addition 0
Porch 0
Finish Basement 0
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
10. CULVERT SIZE
17. COMPLETION DATE
Sq. Ft.
Width
Depth
Yes
No
I hereby certify that I have furnished inforrnation on this application which is to the best of rny knowledge true and correct. I also certify that I arn 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
~Uildi off 'al can rev1Yt~is rrnit r just cau . Furthermore, I hereby agree that ~tcffic;/r6/dnee may enter upon the property to perf0l9n~3D:OSs.
License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee................................... $
V
R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
$
Penalty ....................................... $
Plumbing Perrnit Fee ....................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit............................ $
Other......................................... $
Total Due .............................. $
Paid fI, 0 0
Date / IJ. .3. ().S By
Mechanical Permit Fee ..................... $
Sewer & Water Permit...................... $
Gas Fireplace Perrnit ....................... $
This Application Becomes Your Building Perrnit When Approved.
By Date
Certificate of Occupancy
Issued
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
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificat
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections (952) 447-9850