HomeMy WebLinkAbout1-1/2" LAWN IRRIG. METER
DATE RECEIVED CITY OF PRIOR LAKE
BUII:-DING PERMIT,
TEMPORARY-CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
CTIONS
.':ES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. DRESS
~
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
ADDITION
BLOCK
PID
13. TYPE OF CONSTRUCTION
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
l4. (012.... 28Z;~& ta3""
~. -$
15. NUMBER OF OCCUPANTS OR SEATS
~p~~
OCCUPANTS
If. PE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
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 certify that I have furnishecl 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 offi I can revo i!;,pemlit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
, 951- o;~ 2.S~D
License No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee ................................... $
V
R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
, ,. $
(-
Pressure Reducer .... z.................... $
Meter Horn ............1:11.................. $
Water Meter .......l.~..................... $~ 1~. c;>e
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
/ l.f 0 . <::)0
MeChanical Permit Fee ..................... $
Sewer & Water Permit...................... $
Building ;:;;it ~~2"~tCo
WaterTap ................................... $
Builder's Deposit ............................ $
Other......................................... $
Paid
Jd
Date
24 hour notice for all inspections (952) 447-9850