HomeMy WebLinkAboutBuilding Permit 99-0173
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O'l-/neflcon\c ________ _.,,,t.lCE.~
Inspeelor. _ ___ _____ II .. "OURS III ~O~~IlCE.
f( ,R 1'",e NEY-1 \NSflE.C1\0
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ENTS ARE fOR yoVR pERS
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
T-EMPORARV CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
_ \ 5\99)
. 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
jql/l/l,
3. LEGAL DESCRIPTION
LOT ! 4- BLOCK
ADDITION -7& i1 /1 r-::6 ~
1. DATE
SIHRl L/WL
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4'"f'^ 4;(dt'L
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PID ;( 5" -;;) I~ - fJ7 ~ -()
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4. OWNER -:7
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5. ARCHITECT
(Name)
STO'&K#
(Name)
(Address)
/l/<{(/ (. .s-J/c R ( t. ~
(Address)
(Tel. No.)
llt.! s-- ~S:J
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
t'V\ ($ W)
C<>,\ s t () It tf. :..
'-to? b [; M. C /..; f;.,,; I A-(~.. G~)CQ
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0
New Construction 0 Alterations.,. Addition 0 Finish Attic 0
ChimneyO Misc. A't>'[:l vJINDa....;~ \0 f:-X,...
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS
Sq. Ft. Width Depth
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
"POp..c. M
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
&P.
Cf'r-OI73
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
SEATS
16. PROJECT COSTNALUE
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
building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee m~.y enter upon the property to perform needed inspections.
X ~ nv? ~ :s~~~ 3-1'5""" '1'1
Signature License No. Date
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
SETBACKS: Required
Actual
Side
Side
Front
Back
BUILDING DEPARTMENT VALUATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS
PERCOLATION TESTS 0
SETS
COPIES
o
USE OF BUILDING ~
A/~
OFF STREET PARKING
SPACES REO. TeM P & LAS ~ PLANS & SPECS 0
SPACES ON PLAN ~ To c.oMl>oC~y 0
PERMIT VALUATION '2..::>-.;..v..... PLOT PLAN 0
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
1~1.,
/.. "'2.5"
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 ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid 7 to. -, Receipt No. :3 Ii 71 (;J
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This is to certify that the request in the above application and accompanying documents is in accordance with the c~::03/~dinli and may pr~ as r~ested. This document when
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
This Appli
By
......$ . I
i' permitWhe~~
Date -./1
/
Certificate of Occupancy
$
-<7~-
24 hour notice for all inspections 447-9850
Special Conditions n any
City Planner
Date