HomeMy WebLinkAboutBuilding Permit 99-0947
&~1
DATE RECEIVED
g / '1-'/9'1
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1f. '1003
.
File
City
Applicant
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUEO (Please Print or Type and sign at bottom)
2.SITEADDRESS 1/0/....-, I ('
'f IHJ <-- Ceo! t}./ [,', ele ,).
3. LEGAL DESCRIPTION
LDT
Z 2- . BLOCK
'P.eIOL
ADDITION
4. OWNER J _ !Name) /J
/-..[}"r, ,KP b.f'r<;
5. ARCHITECT (Name)
I. While
2. Pink
3. Yellow
1. DATE
Permit No. --.!29 - 'lc/1-
'8'- 2.-1 ~
BUILDING INFORMATION
11. SIZE OF STnu1,.;1 ut'it:
(Height) (Width) (Depth)
(Address) 'A
/-"1-.1-'7'7/Y.cojlJ V( r
gl/V/l .v.'z.le.
Septic 0 Deck. 0
Addition 0 Finish Attic 0
/CIS t:>
PID
2G:'0 17 - /)"7t?,0
12. NO. OF STORIES
SOl/77-f
(Address)
1t~'L
(Address)
01':
(Ter. No.)
13. TYPE OF CONS1fIUCTION
r.f /Anl'
i 14. FLOOR AREA ApPORTIONMENT USE
GJnv
(Tel. No.)
6. BUILDER (Name)
A.........r,'cc..^ t1,^:Id'A]
LOI\,frv..cl"r.5
7. TYPE OF WORK Fireplace 0
New Construction 0 Alterations cr
Chimney 0 Misc.
/8. PROPERTY AREA OR ACRES /9. PROPERTY DIMENSIONS /10. CULVERT SIZE
Sq. Ft. t- fj'" Width Depth Yes No
I hereby certify that I have furnished infO/maUon on this application which is to the besI 01 my knowledge true and correct. I also certify tIlat I am the owner or authorized agent for
tile above mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance 'Nith submitted plans. I am aware that the
building official ca!l !9>ke thj~rmit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ~--.A" -----..0'/l5'(}nr1 g-_"'Z-?'J
Signature license No. - Date-
(Tel. No.)
"70'7-
695''']
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
Re-roofin!)!!f Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. ~OJECT COSTNALUE
4'"h.7fi{)-
17. CoMPLtfiON DATE
r
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
-ee;;r h/;
;;
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty .......................... ............. $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Back
Side
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA D
PILING LOGS D PERCOLATION TESTS D
PLANS & SPECS 0 SETS
SURVEY D COPIES
PLOT PLAN 0
Cny:
Z-r"VV. (J"V
7~. 7r
I.Z.S
It&t
f,\G
L
Amount Brought Forward .................. ~
Park Support Fee ........................... ~
SAC .........................................$
Collective Street Fee ......... .... .......... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .(j'V.................... $
Paid '1f,. Receipt No.3. ( ~ 7
Issued . ,/,1/ tU ~ I
Date 'ill T, c; -I By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning drdinance a~d may proceed uested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction 10 commence. Before occupancy, a CertifICate Occupancy must be issued.
CijyPlanner
I'f< -c:I C./
24 hour notice for all inspections 447-9850
Special Conditions if any
Date