HomeMy WebLinkAboutBuilding Permit 99-0345
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CITY OF PRIOR LAKE
INSPECT'ON;NOT/CE
SCHEDULED
DATE rIMe
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ADDRESS
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WORK SA TISFACTORY, PROceeD
o CORReCT ACTION AND PROceeD
o CORReCT ~ CAll FOR Re/,,"peCT/O" BeFORe COIlER'''G
Ins_oo ~ Owne'IContc
CAll...,..... FOR THe "EJcTI""pecno" ~
CODE I1EQlIII1E,JfEJvrs ARE FOR YOllR PERsONAL REALm of SAFETYt
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DATE RECEIVED
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3, Yellow
File
City
Applicant
Permit No. qq - 34S
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please,frint or Type and sign at bollom)
2. SITE ADDRESS. J 1 r I (J ""-"
ISSt.{j /J1i'T: ~Ie- 0. ~
3. LEGAL DESCRIPTION
I~
CD tJnON'S v.J D 0 DAlE""'
4. OWNp;) (Name) J I ^ I, L
(r5 PI) tat? {Ime
5. ARCHITECT II (Name)
1~;7rj/17
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
BLOCK
PiD 2-S-030 - 6 r 0 - c)
I n- A:OON.
13. TYPE OF CONSTRUCTION
ADDITION
(Address)
7l~D.-/7I/o
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Address)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
S)el-f.
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish AlIic 0
~
Re-roofing Porch 0
Re-siding 0 'nish 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. COMPLc ttUN DATE
I hereby certify that I have furnished 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 tioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans.
:uilding _ ~1J~t cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform
1 Signature License No.
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
PILING LOGS 0 PERCOLATION TESTS 0
USE OF BUILDING
QES
A/~
I
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SETS
SURVEY 0
COPIES
2-<;lfb.OO
PLOT PLAN
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TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 1'-1-, /5
Permit Fee ................................... $
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty .... ..... .............................. $
Plumbing Permit Fee ....................... $
, .2.5""'
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
GaS Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7(p. 0 0
Paid 7~. 0 0 Receipt No. 35" 0' L
Issued /I":l. /a ~ '
Date 4l!~.~. By "UJ _
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as'~e~ed. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
Certificate of Occupancy
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850
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