HomeMy WebLinkAboutBuilding 99-0538
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DATE RECEIVED
5//3/'?f
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.
QQ-53fS
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
3. LEGAL DESCRIPTION
LOT
(Name)
6. BUILDER
(Name)
1. DATE
s~ '
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
Je./
12. NO. OF STORIES
PID Z5 - 2A":> - () 13 -0
13. TYPE OF CONSTRUCTION
(Address)
(Tel. No.)
~'IO ..~
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
o
-00t J-VliL..
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
So
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
S:.~. V~
Septic 0 Deck
Addition 0 Finish Attic 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
SEATS
16. PROJECT COSTNALUE
I 0 C;9.-
17. COMPLETION DATE
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 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 official can revoke this permit for just cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
Signature
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
.e6:5 ~/~
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 -0 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
........... $
License No.
Date
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. 01 .ANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT VALUATION 'I ~OO .C)~ PLOT PLAN 0
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
$
S-<>>.1S-
3~.8q
.~O
~
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
uilding Permit When Approved.
Date S-{ r-? '7
Issued
24 hour notice for all inspections 447-9850
White - Building
Canary - Engineering
Pink - Planning
The ("("nler of the L.ke Country
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
Reviewed By:
~~~
Date:
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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."
qq-538
The CrnCrr of Ihe Lakt Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
~-4,eK.. /!ENN6N
5//3/qq
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
LIft:; ~0 OrJKWO()D C--/ Ie-_
Accepted
Accepted With Corrections
Denied
Reviewed By:
Date:
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."
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