HomeMy WebLinkAboutBuilding Permit 99-1195
DATE TIME
CITY OF PRIOR LAKE 11- 5" -'1'1
INSPECTION NOTICE SCHEDULED A'r
ADDRESS --1!::LZ2.!d Cw-Jle.wocJ
OWNER CONTR.
PHONE NO. PERMIT NO. ,\q- Ilq 5
o FOOTING o PLUMBING RI o EX/GRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING ~ o WATER HOOKUP o FIREPLACE RI
~SULATION o SEWER HOOKUP o FIREPLACE FINAL
INAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
Inspector:
Owner/Contr:
E NEXT INSPECTION 24 HOURS IN ADVANCE.
ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
------_.._-_._-_."'.._~--_.._,_._...-...,._----_._._---~.._..__..-
DATE RECEIVED
9pO/1Q
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.
9tf-/I1S
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
,
.fVI)
BUILDING INFORMATION
1,. SIZE OF STRUCTURE
(Height) (Width) (Depttl)
3. LEGAL DESCRIPTION
II
.:5/1/l/ 0
12. NO. OF STORIES
LOT
BLOCK
p-;
2-
4711
PID 25-2/5-02-1-0
13. TYPE OF CONSTRUCTION
ADDITION
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
(Tel. No.)
7. TYPE OF WORK
Fireplace 0
Alterations 0
(Tel. No.)
q 3 3-3SJfc
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
6. BUILDER (Name)
Coff ~o/V6I.:t/Vt!.
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Porch 0
Finish Basement 0
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION 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 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 official can rev e this ermit for just~. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed Inspections.
X C' r q :3 ,.,t,
Signature license No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILEO WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
"
USE OF BUILDING
.eer /1/r-
-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
25l5V. c/V
PLANS & SPECS a
SURVEY a
PLOT PLAN a
SETS
COPIES
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
City:
Amount Brought Forward .................. $
Park. support Fee ........................... $
SAC ......................................... $
Collective Street Fee .... ................... $
Sewer Tap ................................... $
$
Division 1 2 3 4
Permit Fee ................................... $
7{.t>
Plan Check Fee ............................. $
/. L\
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
r uilding Permit WhenjjProM7
Date ~ ~O
I
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Paid
Issued
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zonin Ordin e d may proceed a 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.
City Planner
Dale
Special Condrtions if any
24 hour notice for all inspections 447-9850