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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
5/31/~
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
S
5:6
3. LEGAL DESCRIPTION
S-
MIeo/.AI /It-
-/
.3
Jet066
1. White
2. Pink
3. Yellow
Permit No.
1. DATE
12. NO. OF STORIES
LOT
BLOCK
PID 2.5-3/" - (J3/-0
~
13. TYPE OF CONSTRUCTION
ADDITION
5. ARCHITECT
(Name)
6. BUILDER
(Name)
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
Re-r ing 0 Porch 0
Re-siding 0 Finish Basement 0
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 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 prop nd that all constructio ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building official c 0 permit' st e IJrthermore, I hereby agree that the city official or a designee may enter upon the property to perform ~eded inspections.
X ~"J/-Ot7
License No. Dale
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
L'-es IJI~
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 ~ 4
Permit Fee ................................... $
Plan Check Fee ............................. $
(B7 S U
(oZ. 25
'fa,~6
/. (){)
City:
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
~
Sewer & Water Perm~ ...................... $
Gas Fireplace Permit ....................... $
~~isA~me~Eng ~:tr:it~iz:l;/;/
Certificate of Occupancy
Issued
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
, IJd
PLOT PLAN
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning rdinance and may proceed r quested. This document when
signe by the Planner const~utes a temporary Certificate of Zonin1j comPlian~.nd allows construction to commence. Before occupancy, a Certificate cupancy must be issued.
(1~&-Ci*O . ~p:;; C~((S(' p-6'Ir ~!:-
Cny Planner Date . Special Conditions ff any
24 hour notice for all inspections (952) 447-9850
00 /04100
The Center of the Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLlCANT.uk1 c 0 ~ J~ \d. Q;1~
APPLICATION RECEIVED :s \.,J'0-.L \~... ) d CXJD
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
SqLll ~~~ ~E
Accepted With Corrections ~
Accepted
Denied
Reviewed By:
Comments: Re-A.D
~ ::j..u1Jf.-; Date: ~/z/o()
J)ecJt:- I-1l4lftJ -{JuT AIJo ALL
;tJR;t2.- rA.ATION tJAI 7ft&' NPMtJtFLJ PLAtJS'.
rITe-
t
"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 Cenler of the take Counlry
DO,(Q~~
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT J lAJQJJ C () .~ J 1\0. 9.f'~
APPLICATION RECEIVED -:SC~L \ '~'~l ~ cco
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
S/ I t r l' .
'-" ',"--. '/ ," . \ <"",'-.,', "" \ _ '.. / -~"-..; '"-"-1k~.. ;:~\
'" \ I ~,~ C......:::l,\.f {; .1 "..{ ...J \ "_ L-",~
~E
Accepted
~
Accepted With Corrections
Denied
~.~
Date: c,,- cg - &?
Reviewed By:
16
fXi~ CiO I SSU~ L
"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."
..
.
- --.., --.....--.----.--------.--.--. -.- -- ... ".-,.'---.__.._._. ______ u_,,___ '. ____. _ _.._._._....__...___~ _ _ _ _ _ ___' ____, ._...____...~__ _ ._._______._~___,,~.....__.__
- ---- -"....,.-.- - ------"..._-----'_.._'_..._-~._-----------_._._._-~------..
PRIOR. LAKE
INSPECTION
RECORD
SITE ADDRESS 59yl CkJ5SANJ},eA J9., ,.;',6,
TYPE OF WORK A!'E-vJ J)cCl~
USE OF BUILDING ~E$ A/~
PERMIT NO. 00 - 04ww DATE ISSUED W C-1/cJcJ
BUILDER WElS-C/) ~UIL-LJc7e.s '#. 95Z-8?O-.3:J5"Z-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR DATE
J FOOTING ' I ~ I '/z Z/a-t1
~E NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
.... .;~ ~. I 6:.. I ~/a-aflt"<!
I FINAL
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-9850
.