HomeMy WebLinkAboutBuilding 99-0557
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNEC ON PERMIT
(Tel. No.)
f Jl-
W. ~fN~ ~3t{
(Tel. No.)
r1. q Cj(, - 0 ;S2Ct
&~~
DATE RECEIVED
NAY J 81009
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
EFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
I
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6. UILDER (Name)
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p,..- H..J:\~Vt~ <5
7. TYPE OF WORK Fireplace 0
New Construction 0 Alterations 0
Chimney 0 Misc.
(Address)
Septic 0
Addition 0
Dec
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq-557
ATE
_-.;- .- l'1--49
leI
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
17. COMPLETION DATE
I hereby certify that I have fumished 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
i1din fficial c revoke this permit f r just c se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorm needed'n actions.
,--- Jl-/7
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
License No.
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
',7tJO .00
USE OF BUILDING
/<!.o'O A/~
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM (!J'
Division 1 2 ~ 4
Permit Fee ................................... $
S U
City:
54.00
35.10
.<8S
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
1\ !fi I~~
~,
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
ilding Permit When Approved.
Date t:; - ')./-'1C,
Certificate of Occupancy
Issued
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SETS
COPIES
SURVEY 0
PLOT PLAN
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $ __
Total Due .............................. $ gq .cIS
Paid ~ q Jj" Receipt No. S l:"""~""S ~
QQ-5s7
The ('tnter or the L.kr Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
8R./AN 1'1/7R-T7N50N
5j/B /qq
.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
q'-l3'-! (!,oAeHMFI;J L-N.
Accepted
Accepted With Corrections
>L
Denied
Reviewed By: aJ ~-
Date:
s-- 2J-? '7
Comments:
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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."
White - Building
Canary - Engineering
Pink - Planning
The ("tntrr of Ihe L.kt Counlry
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 ')0 h \A.. Accepted With Corrections
v
Denied
Reviewed By: ~ ~
Date:
0" 2- ~ ~0CJ
\..
\~{ANV~./ ,
"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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