HomeMy WebLinkAboutBuilding 02-1157
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DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 0;;) -//5/j
~~
BLOCK <X.
~hmokl()
I
1. DATE
q-ID ,--0 :J-
~. 1< -;)-
lPffi;Jb3- 0/1,-0
13. TYPE OF CONSTRUCTION
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 ) h 1 D q
3. LEGAL DESCRIPTION
LOT I,-q-
ADDITION
BUILDING INFORMATION
11 . SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
14. FLOOR AREA APPORTIONMENT USE
Fireplace 0
Alterations 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
6. BUILDER (Name) (Address)
~~J~4~
&:'1;/" 7<?'Lf
~bY 10
SEATS
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Porch 0
Finish Basement 0
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
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 Utat 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 official ca evoke this rmit for' st cause. urthermore, ~ hereby agree that the city official or a designee may enter up. n the property to perform ne~ed ins~tions.
X
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
PERMIT VALUATION
62 57JO.---
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee nu.uuu'..u.....un...unu. $
V
R S U
City:
Amount Brought Forward .......n......... $
Park Support Fee u.nu.u..n.uun.un. $
SAC u........u.......n.u..u......uu.u $
Collective Street Fee u..uunun...uuu $
Sewer Tap .....uuu.....nunu.....nun $
7L( 7tJ
Plan Check Fee uu...nu...unu...uu" $
State Surcharge uuuuu..nu.nnuu..u $
Penalty ..uu..uuuuuu..nuuun....n. $
Plumbing Permit Fee ....n.....n.....n... $
Mechanical Permit Fee ..u.....u.....u... $
$
rJS
Pressure Reducer unu..unun....uuu $
Meter Horn un.....uun....uuun....uu $
Water Meter ....nuu....uuu.....u.un. $
Sewer & Water Connection Fee uu.n.... $
Water Tower Fee .....unu.....nunu... $
Sewer & Water Permit uuuuuu,nnu'" $
Gas Fireplace Permit uu..nu....uu.uu $
Water Tap uuuu..uuuu..uunuu...u $
Builder's Deposit .uuuu.....uuuu..uu $
This Application Becomes Your Building Permit When Approved.
:.....,. ,,""pacq D.., ~:~';;~i::;;:::::::~:~~o: :!!J i C;%
Issued
Date tJ-/3 -00-- By CftJ/
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 as reque'J;d. 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.
City Planner
Date
Special Conditions if any
24 hour notice for all inspections 447-9850