HomeMy WebLinkAboutBuilding 08-0150
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DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I~~(
( D~~I t-lGt f;.BJ
--
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
08.0/S0
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
/ fog "2-
1. DATE
PIf- dI-07
S.E.
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
ADDITION
BLOCK
PID
13. TYPE OF CONSTRUCTION
Fireplace 0
Alterations 0
Septic 0
Addition 0
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
(Address)
6. BUILDER . (Name) /1. ~
~.8~~ '-'1Cr.
(Address) _ . _' // L) .d (Tel. No.).
~<1bO-::r~~ ~. ~~~ /00
~//J:bt- 4S'~-i0"1-09~
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Deck 0
Finish Attic 0
Porch 0
Finish Basemenl 0
SEATS
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
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 offici an revoke this '1 for just cause. Furthermore, I hereb agree that the city official or a designee may enter upon the property to perform needed inspections.
X . ~/~q.3S~ Cf~-07
License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
8ack
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
USE OF BUILDING
o
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 <, 4
Permit Fee ................................... $
V
R S U
City:
Amount Brought Forward .................. $
Parik Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ................. ..... ....... $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom... ................. ........ ....... $
Water Meter................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ............... ....... $
Gas Fireplace Permit ....................... $
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proce
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certifi
s requested. This document when
of Occupancy must be issued.
This Application Becomes Your Builcling Permit When Approved.
By Date
Certificate of Occupancy
Issued
Paid
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850