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CITY OF PRIOR LAKE (~) PUl!J 5
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT Permit No,
DATE RECEIVED
7/5/00
1. White
2. Pink
3. Yellow
File
City
Applicant
oo-OS(g~
DIRECTIONS 1.OA '
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. /d)ORESS '0M 2 t1/ EST B (/ 11//6 S IIV
3. LEGAL DESCRIPTION
LOT
ADDITION
4. OWNER
4-
(
" (Address)
'\:SIlM
(Address)
5. ARCHITECT
(Name)
C1NOS
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
te-I
12. NO. OF STORIES
PID
25-295- 027-0
13. TYPE OF CONSTRUCTION
jJel. No.)
A&vc
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
(Tel. No.)
'1'/11- 86~ (, /I
~1IIf ( II~ 801.1'
Deck" Re-roofing 0 Porch 0
Finish Attic 0 Re-siding 0 Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
(Name)
(Address)
\.\
Septic 0
Addition 0
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
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 ~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 wit"" submitted plans. I am aware that the
b .. official can revoke th' permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perf rm eeded inspections.
X . - 3~
License No.
SETBACKS: Required
Actual
Front
Back
BUILDING DEPARTMENT VALUATION
FOR ADMINISTRATIVE USE
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
USE OF BUILDING
I!?F~ ~/L
I
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
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 (1.,3."'1 /
Date . /1- " f/l) By
request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may procee s requested. This document when
nner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
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 ................................... $
(g2 .?. e;;'
L(O .lfb
1.00
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
our Building perm7-r::proved.
Date - - (!)C/
Issued
Date
24 hour notice for all inspections 447-9850
Special Conditions n any
PLOT PLAN
o
City:
11" \00"':1.0
~f) ..~,...
tJ 0 "",$ t',\b
~ /)00 " vD
i'l' IL"
e-/~
,vii 6 1/11
~ 1fJfP'
DO .o5lu!
The ('l"nlf'r of the Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
DAN HG,/6/f!...
7/5 /00
I I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/fo84-z. f,A/6S1BU,ey ftV6 SW
Accepted ~
Accepted With Corrections
Denied ~ ~
Reviewed By: - - ~,
Comments:
Date: 7 - G. .. 2~c>
"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 Center of the Lake Country
I (I
, l ! (! X
I \..; , ,) J i'
\.,
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
lei / j\/ 1/ EVE f;.:...,
,
7 /,~ leD
/ I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ft: E4-Z-
'i"'~'---I 'j2'(, ."~..
t.. V L..- ....,-, L,/ 1../ K.
II ~. 'F-
:c)~~
Accepted
Accepted With Corrections
Denied
j
,
.,
Reviewed By: /
Comments:
Date:
-..
"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 JlnB4z... W~~ \nll~ ~
TYPE OF WORK ~
USE OF BUILDING SFD
PERMIT NO. ()O. D5(P~ DATE ISSUED ,-t..r, -'2c.cx:)
BUILDER n", ~
NOTE: THIS IS NOT A ERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
,
I FOOTING I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
J II!JlA'MUlJv. I I
I I
INSPECTOR
DATE
I FINAL
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-9850