HomeMy WebLinkAboutBuilding Permit 99-0411
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PERMIT NO.
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o fOUNOATION
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o INSULATION
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o SITE INSPECTION
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o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
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WORK SATISf"CTORV, PROCEEO
o CORRECT ACTION ANO PROCEEO
o CORRECT WORK A\..\.. fOR REINSPECTION BEfORE COVERING
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INSf'lOT1
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om 00,,01'lEQ 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. ~q- 4-//
, DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
2. SITE ADDRESS
QJ9C
3. LEGAL DESCRIPTION
(p ~ 7
W~ST s/O€
c;--9J.-f1
BUILDING INFORM"TION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
/:.7 /., h? ~.rJ
5' h..,<'7-
12. NO. OF STORIES
LOT
BLOCK
PID~'OOS'02.I- a
ADDITION
"""ooAl.
4. OWNER
(Name)
7-l ~.?
(Tel. No.)
13. TYPE OF CONSTRUCTION
t, r CJ rrP, a-:r'
14. FLOOR AREA APP~NMENT USE
5. ARCHITECT
(Name)
(Address)
n "-,-.,.,,,,'1
(Address)
(Tel. No.)
6. BUILDER
(Name)
(Address) (Tel. No.)
9:;8t:
&-r~~ 4//~",? /loa
Deck 0 ~e-roofin~ Porch 0
Finish Attic 0 Re-siding 0 Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
~!rO/7 r,.rzcJf:r.>r
7. TYPE OF WORK Fireplace 0 I ~tic 0
New Construction 0 Alterations 0 Adt$tion 0
OCCUPANTR
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES /9. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
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 mentioned property and that aU construction will conform to all existing state and local Jaws and will proceed in accordance with submitted plans. I am aware that the
building official_can r~eJPiS ~it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X "-7/ 'tCL.--- L/ _ -2 -C2 _ 99'
~/ Signature
(
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
LicensaNo.
0."
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
D ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
12bS A./e.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS CJ PERCOLATION TESTS 0
USE OF BUILDING
PLANS & SPECS 0
SETS
SURVEY D
COPIES
2.,:> VU.6D
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 ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... ct:
$
Division 1 2 3 4
Permit Fee ...................... ......... .... $
71./-.7r:;-
Plan Check Fee ............................. $
State Surcharge ............................. $
Penany .............. ......................... $
1.2<::;"
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... ct:
MeterHom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Gas Rreplace Permit ....................... $
Water Tap ................................... ,ct:
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $-..::2I~ .n()
Paid 4-{."...Jii'f Receipt)Jg. '350c:..4-
By J,JtL.-
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
Date -z(,..tTV
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 is requested. 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.
CityPJanner
Dale
Special Conditions if any
24 hour notice for all Inspections 447-9850