HomeMy WebLinkAboutBuilding 02-1004
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02:02:00 WED 12:5~ FAX 612~~7~2~5
CITY OF PRIOR LAKE
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DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT.
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. Whil.
2. Pink
3. YellOIll
roil.
CilY
^rplk""1
Permit No.
02-/004---
OIR!;~T10NS
SPACES NUMBERED 1 THFlU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Ple8:0e Print or Type i1nd sign BI bonom)
BUILDING IN~ORMATION
1,. SIZE OF STRUCTURE
(Heighl) (Width) IOOPlh)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
ADDITION
BLOCK
PID
13. 'TYPE OF CONSTRUCTION
(Addross)
t::
(AOOreSS)
14. J:LOOR AREA Af)f)ORTlONMENi USE
(Name)
(Name)
Fireplace 0
Alterations 0
Dtck 0
Flni5h Alllc 0
'11'77 tlt..J4!f~J.J I (Tel. No.)
pl,-,~ k,...} f.1';.,r;?Ll /~8'&'
Re.l'Qoflng 0 Porch 0
R1iH.idi,. Fini6h Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
7. PE OF WORK
New Constl\Jctlon 0
ChlmnllY CJ MISC.
B PROPERTY AREA OR ACRES
SePtic 0
Addition 0
OCCUPANTS
SEATS
~q, Fl.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
I hereby eel'llfy thaI I h ve rumi ed infolmallon on this application whlcl, Is to the best of my KnowlerJg~ truEl and correct. I also CQl1ify thaI I am the owner or authorized agent for
Ilnd hal all con5tNction will conform to i11l nisting state and IOCilllBWS Bnd will proceed in accordance with ~ubmlned plans, I am aware thaI the
spit for Just C:lUse, Furthermoro, I hereby agree that the city offlcl::!1 or a ZI9~OO. may ontor upon IhG prOp91'W to ~er1orm needed in5peclion ~O
_.__..___ ____..._.. _ .3:3 t., 'f<.
"" lIcen8e No, Dale
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Sack
Sl~e
Sld&
SOIL TESTS
o ENERGY DATA
o
;ees AI' /e..
OFF STREET PARKING
SPACES REO. ____.,..,.
SPACfS ON PLAN
PERMIT VALUATION
PILING LOGS CJ f)ERCOLA TION TESTS Cl
BUILDING DEPARTMENT VALUATION
USE O~ BUILDING
PLANS & SPECS r.J
SURVEY fJ
SETS
cOPies
PLOT PLAN
o
'TYPE OF CONSTAUCYION: I II III IV V
Occupancy Group A B. E F HIM R S U
DM.lo~ 1 2 3 4 t,t s
Perltlil Fee .........................,......... $ 7< . 7
Issued
Amount Brought Forwarcl .................. $
Park SlJp!'ol1 Fee ........................... $
SAC ......................................... $
Collaclive Street Fea ....................... $
SewerTap ................................... $
S
Pressure Reducer ...............-.......... $
Meter Horn ..'................................ $
WOlter MeIer ..........................'...... S
Sewer & Water Connection Fee ........,.. $
Water Tower Fee ...................... ..... S~
WlIlerT,,, ................................... $
Bull<lcrs DopoSil ............................ $
Other ......................................... $
Total Due ............................... $
Paid r ~? 0 () RIC9Ip! N .
Date I" ~,o Z-- By
Thl~ I~ to cl!rTlfy thaI mB reque5t in the ..bov.. application and aceompan\,i~g documQnts Is In accordance with t~e City Zoning Ordlnan~A Ilnd m..y procAp.d rp.que~'Bd. Thi~ document when
Sigoed by tM City Planner constitutes a t"mporary Certificate of Zoning compliance i1nd allows construction 10 commonco, Belolo OCCUPMCY, a Ccrtlflc:lte of Occup3ncy must be Issued,
City:
Plan Check Fee ............................. $
Stale Sun;hBT98 ............................. $
l.z5
P9natty ....................................... $
Plumbing Permit Fee ....................... $______
MlJchani~i Permit FQQ ..................... $
Sewer /I. Waler Pormlt ...................... $
Gas Fireplace Permit ....................... $
Ihls Application Becomes Your Building f)ermlt WhOn ApprOVed,
By Date _'__
CMlrlcato 01 occupancy
Cil'y PI:,"nn!'
OalO
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