HomeMy WebLinkAboutBuilding Permit 99-0398
City of Prior Lake DATE
Inspection Notice
"
SClJ..EDULED
10/25/99
ADDRESS 15777 SKYLINE AVENUE NW
OWNER CONTR
PHONE NO. PERMIT # 99-398
TYPE OF INSPECTION RE-ROOF
COMMENTS:
~ Work Satisfactory, Proceed
o Correct Action and Proceed
:spect:~rrect wO@Jor Reinspection B::e::::::g
TIME
A.T.
..._-~'----_..,-^--_...,_._--,_..._.._-
~1
QATF RFCOFIVFn CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING. COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3 Yellow
File
City
Applicant
Permit No. qq - 3Cf 9>
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 -...
J<lj71
1. DATE
Lt/; 9/c;Cf
LOT
, .
~VLuvf ~,E ;t/ t-,./,
5 PID 25-/1./-3- 0(,,"1- 0
1ST' ADDN.
,
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
(p
ISLAN"D
tOCL.AvO~me)
15. ARCHITECT
6. BUILDER
12. NO. OF STORIES
ADDITION
BLOCK
VlbW
13. TYPE OF CONSTRUCTION
/?. (Address)
I u,cA t:A...
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Name)
(Tel. No.)
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
crfl/-jl{ A 0(0,/1/6 ..J /}fiIZ-tCXJ{?L/-vL., / /f.,c
7. TYPE OF WOAK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deckl!J
Finish Attic 0
Ae-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
18, PROPERlY AAEA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have fU~ iS~ information on this apPlica. tion which is to the best of my knowledge true and correct. I also certify that I am the 0 wner o.r auth. orized agent for
th~ ~tJi:~:ned prope~ n t~at !structiO will conform 10 all existing stale end locallews and "'" pmceed in eceordance wilh submitted plans. I am aware thallhe
:UIldlng ~~e t?.. rmlt for ore, I hereby agree that the city official or a deSignee may enter upon the property to p~r1orm ~edr ispe?/i'
/ Signature \ License No. {Dale ~ I
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PIUNG LOGS 0 PERCOLATION TESTS 0
BUILDJNG DEPARTMENT VALUATION
,
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
USE OF BUILDING
~~ NIL
2.<;<5().n'J
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... <l:
Collective Street Fee ... ...... .............. <l:
Sewer Tap ................................... ot
Division 1 2 3 4
Permit Fee ................................... $
7c.f.[~
PJanCheckFee ............................. $
State Surcharge ............................. $
I . "2-':;
$
Penalty....................................... $
Pressure Reducer .......................... .If:
Meter Hom ................................... .If:.
WalerMeler ................................. $
Sewer & Water Connection Fee ........... If:
Water Tower Fee ........................... 't
Water Tap ................................... If:
Builder's Deposit ............................ <t
Other ......................................... $
Plumbing Pennit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Pennlt When Approved.
By I)ate
Total Due .............................. $
Paid 7{a . (fU Receipt No.
Issued
Th~ Is 10 certify thaI the request in Ihe above application and accompanying documenls ;s in accordance "'lh the c~:;oni:/:'n:"!. ~d~aY pr::ed a ~quesled. ms documenl 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.
7&.00
35D~
Certificate of Occupancy
CityPJanner
Date
Special Conditions it any
24 hour notice for aU inspections 447-9850