HomeMy WebLinkAboutBLDG 07-1146
CITY OF PRIOR LAKE 1. While File
BUILDING PERMIT, 11 ; ~:I~Ow ~~~licant
PORARY CERTIFICATE OF ~L'H >fk.Jf7~ ()lJ
ZONING COMPLIANCE 'PVYy~ I .
UTILITY CONNECTION PERMIT Permit No. 07 114-h
DIR TIONS .
SPAC NUMBERED 1 THRU 17 MUSi-81(FILLED IN
BEFORE P ~Iease Print or Type and sign at bottom)
1. DATE
2. SITE/5!i/S ~ ~
3. LEGAL DESCRIPTION
1/. ~O. tJ
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
~
12. NO. OF STORIES
(Name)
(Address
/ SVs &'
(Address)
PID
LOT
BLOCK
ADDITION
5. ARCHITECT
(Tel. No.)
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
(Address) (Tel. No.)
('S1) 7,1./-:L' q./p
A. ,;f~ ~o-k.c-, rhn 5OD/l../
Deck 0 Re-roofing 0 Porch 0
Finish Attic 0 Re-siding)t: Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
6. BUILDER (Name)
~~.~.
411./
OCCUPANTS
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
SEATS
16. PROJECT COSTNALUE
/7, /)~o . ~o
17. COMPLETION DATE
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 m ioned property and that all const tion will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building 0 lcial c voke thO permit for jus e. F rthermore, I hereby agree that the city official or a des~ee, m?y pjter upon the property to perform ne~d inspections.
X J-, ~6 1/. OlO.07
License No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Issued
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit............................ $
Other ......................................... $
Total Due ......................... .. . $
Paid '1 Ct rlJ
Date If. ~ ,/7
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proc e as requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certif e of Occupancy must be issued.
Mechanical Permit Fee ..................... $
Sewer & Water Permit...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
C~y Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850