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DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
MAY 2+!99q
Permit No.
qq'-Sq9
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
1. DATE
5 -2L(:-q'1
i r I j'Y\.. S ~...J
cr
IC I SO
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCR~TION
LOT U7 BLOCK
ADDITION {,{. J; (&{t1/ /.JA-
4. OWNER (Name)
'"Do' \-. e_ VV'\ b e de
5. ARCHITECT (Name)
12. NO. OF STORIES
)
p{)-J'1dS
PID ;;;~- - 3/~ - Q[J0 -(J
13. TYPE OF CONSTRUCTION
(Address)
I ,,( b 7 C-{ I flI\-'::(,-I L
(Address)
(Tel. No.)
L/'-j[)- C 6,3 (p
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
I hereby cert~lthat I have furnished information on this application which is to the best of rny knowledge true and correct. I also certify that I am the owner or authorized agen.t for
the above m tioned prope 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 offi 'a can revel permit f7~j~s.. t ca se. Furthermore, I hereby agree that the ~ty official or a designee may enter upon the property to perfo~ needed inspections.
X ~ L-S/2,jtfct-'8'~7-670 lj-7J)-qq
Signature License No. Date .
Front
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. PLANS & SPECS 0 SETS
SPACES ON PLAN 4 SURVEY 0 COPIES
PERMIT VALUATION fli./OOO, 0 0 PLOT PLAN 0
J
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
Itcs /1/;<
, I
TYPE OF CONSTRUCTION: I 11 III IV V
Occupancy Group A B E F HIM R S U
Ii 8'7. d- 'S
Permit Fee ................................... $
Plan Check Fee ............................. $ ~S~. 7 z..
1# 2. 00
Cify:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC .........................................$
Collective Street Fee ....................... $
SewerTap ................................... $
$
Division 1 2 3 4
State Surcharge ............................. $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
~(3Iqq
@ft
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Penalty....................................... $
Sewer & Water Permit ...................... $
i1ding ~:;;it ze: ~o';!rr
Certificate of Occupancy
Issued
24 hour notice for all inspections 447-9850
The Center of the t..kt Country
qq-599
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
DO UG; L..I~MB6CI<-
5" /2-4/99
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
)h9{c;7 CR./M-SOA! c-/.
Accepted
Accepted With Corrections
Denied -BJ/J I
Reviewed By: W/v<</~
Comments: J
11~J4~~1 .
Date: U - -z-q ~
"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 Cc-nlrr of the Like 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: ~-,~W-a~
Date: (p -2-~Cj
Comments:
~~'To Lsa0i;p_ ~~ 1von~ ~
~\Lp ~y- ~ ~ *~ ~ IJe-v~~ ()eLk ~I
~9W ~~( ~vee~ V'~veJ.
"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
RECORD
SITE ADDRESS ~l.o 7 ~(2..( t\t\:s a N C.J\
TYPE OF WORK N E. W 1) ECJ<-
USE OF BUILDING S~O
PERMIT NO. ~ - zscr9
BUILDER ~ ~c.S-e _
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
DATE ISSUED
(; - G -q1
, -
INSPECTOR DATE
I FOOTING ,5 '#no -rb,1 &:t-. I I ItJ. S - r;c;
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
i~ I I
I FINAL I I
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-9850
/