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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
DATE RECEIVED
r; //7 /c17
3. LEGAL DESCRIPTION
LOT 5"5 BLOCK
/Nt;VAOONA
ADDITION
6. BUILDER
(Name)
5<(-'2
7. TYPE OF WORK
New Construction 0
~D
~
Septic 0
Addition)<.
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
CITY eF ..ftleR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1'~~/17
h C/( S.W
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
QC(-I/+4-
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
LA ~ d Of'lC1
12. NO. OF STORIES
PID 25-09.5- 044--0
13. TYPE OF CONSTRUCTION
BEAcH
14. FLOOR AREA APPORTIONMENT USE
~
(Address)
(p (l..- 72.' ~ ;...,'Z--
(Address)
.-,
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Deck 0
Finish Attic 0
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
I he~eby 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 that all construction will conform to all existing state and local iaws and will proceed in accordance with submitted plans. I am aware that the
building official c voke this permit r just ause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to per10Z ne~d ,spections.
X ~ q - / / L~ '7
License No. 6ate
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
~o5 A/~
.
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 ................................... $
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty .....................l).p..::...~..... $
Plumbing Permit Fee '''1"]""..<':111*
Mechanical Permit Fee N.,/!:f/-/I.1.I$
Sewer & Water Permit...................... $
Gas Fireplace Permit ....................... $
This
By
co es Your Building permittth'!LAPPIJJ,V2('
Date - l-'t
Issued
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION 10,000.00
PLANS & SPECS 0
SETS
COPIES
SURVEY 0
PLOT PLAN
o
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
I (.'2. ZS-
10$". 4~
S,OO
'10.00
41l.uo
Pressure Reducer .......................... $
Meter Horn .................... .... ........... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ ~';'Z-. "1L
Receipt No. g~ 30-0
~
Date
Special Conditions tl any
hour notice for all inspections 447-9850
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D:IS"7'IH;; BUILDING !~I\.TIO ... ',3.7%
LOT iI.RE,.<\. == 5,cno s:~. F"T.
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\ PRO?OSED ::;t.R.AGt" ARE.'" ,-= 532 S.F.
PROPCS~D 3UtLDIi'IG RA "'"10 == 24..3%
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VERIFY ELBVA TIONS c.':c
DiMENS'IO~VS PPIOR TO
CONSTRUCTTON
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APPROVED
PLANNING [, EPT
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Signed Cat8-'-'
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q 7- l/'1i
Thf Crnlu or th~ L.k~ Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT OO"l.Mp/()V1_ c::
APPLICATION RECEIVED 1- 17 - 9 7
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I It,LI&{ () IV\jl)c{ &(")V'\A ~nc~ Qr'J-
4
Accepted
./
Accepted With Corrections
Denied
Reviewed By: 0/11l..-T€.12. El-it?c:S MF/NA./
Date:
. I
/o/~/ 'I'}
.
Comments: 1Hc l,..)6:,I^-.JE€fl..I,.J(, j)tPf"t-(LrMErJt
H,qs. Ala Is.svE"S W/n-f
hJc.
?~o~osaJ
6'naAGE
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,
EVil n".sr. 4-o(),TIO,,-..
S E:e:
INF..,fIJvI..a.no^-.1
0,.) KEl..lfRSE SIDE:".
5e.E. A-rr-AlH r\of~' /. ht-JA-L. GnADE / N<,Pt'"CT1o"J /1JFoltMATiorJ
1. Ea..os 10,..) C.,.vrfLOL. (Vl(~A:.u,u::s
3. &.05 ,ON CO^,/~L. .j{{l~
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
The- Ce-nle-r of Ihe Lake Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
/
Accepted With Corrections
Denied
e./lf ~ _ Date: qj23/f1 IC>-'-fj
;;2~~<<~Vh -~A 1M Uf~od:
/VVlJ cAcvn~ 'to ,{/j~t1/;O ~tL a -
~;tLuo.n1 a J4iffDn .-fD LtC [Liked ~
-tw(,fio{j '?S<-c&ucJk- - Sd1ouJto - OIL
Reviewed By:
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
CJQ-//4-4--
Thr Crnlrr of lhr Lok. Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
(!O/"?PTO/\IS
q~7/qr
,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/64~~ /NGV'100/\/A- 867JeH e/R-
Accepted
Accepted With Corrections /---
Denied ~
Reviewed BY,( ~--
Comments:
Date: 1-1( -~ (
~Q.,'~ktv\- ~(~ GonJ:-hYt
1.. N~ Dcc..uy?~ "1._
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"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
PRIOR LAKE
INSPECTION RE'CORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS jw~lo Iv.JlJO..~~ ~~ Qr
NATURE OF WORK _R~~oc~ ex\s\~ MdJI\J-..... q ~~~ ltusS-Q~
USE OF BUILDING ~FD
PERMIT NO. 'l1--ll'-fL! DATE ISSUED C,~27-1 r
CONTRACTOR Q~_~~
NOTE: THIS IS NOT A ERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING ~@ I Or, ID~l'~~
I FOUNDATION (Prior to BackfillY@) I IJtI lID" trr!1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
CJll> _ :~......
I' <:;:-........J
5-!!r-Al .p~~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
- I I
FINALS
rI +, ~q: 6 4--
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This cdrd must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850