HomeMy WebLinkAboutIrrigation Meter Permit
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
.
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While - File
2. Pink City
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Permit No. \ )
...........
. 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
34 7 r'")
3. LEGAL DESCRIPTION
1. DATE
LOT
ADDITION
,
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BLOCK '2..
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (DBpth)
12. NO. OF STORIES
PID 25-3sl -Q:)! ~O
13. TYPE OF CONSTRUCTION
4. OWNER (Name)
uJ CNS~ANJ
5. ARCHITECT (Name)
(AjreSS)
~C.
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
6. BUILDER (Name)
t..J~ LJ~
(Address) (Tel. No.)
/J'i~(~"'D- C.>/-yot'Vy~<J
~ dlOlJ C ~ /11
Fireplace 0 Septic 0 ~Ck 0 NRe-rOOfing 0 Porch 0
Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0
YV\~~
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
2>
SEATS
16. PROJECT COSTNALUE
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPI;RTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
I hereby certify that I have fumished information dn 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 .9f!irial can revoke .l!Jj8'perm7" or jus~use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X /J ~~ ~. _~ 1~->7 7-7-?7
. d r /'9nature License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
o
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
OocupancyGroup A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
City:
Amount Brought FOlWard .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
fll\ressure Reducer~.~.J~.t?.~........ $
Meter Hom ......................"to......... $
1." Water Meter .3e..~~s.~............. $
Sewer 8. Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ ""2-~. PO
Paid "2...355. Va Receipt No. "?>S0'-\"
Date ,I., I Cfe; By (L.(J (4
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordina~cJ and may proceed as requested. This document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certnicate of Occupancy must be issued.
Plan Check Fee ............................. $
State Surcharge..................... ........ $
Penalty ....................................... $
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Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
.
......... $ f r
lilding Permit Wh~~//:)r:
ate .~
Issued
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850