HomeMy WebLinkAboutBuilding Permit 99-1199
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
ADDRESS
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59/ <'/ C;eoss/l/Vo~
SCHEDUL,ED
OWNER
CONTR.
PHONE NO.
PERMIT NO.
99-1/7 C)
o FOOTING
o FOUNDATION
o FRAMING
o INSULA nON
o FINAL
o SITE INSPECTI
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
g,.,GASLINE AIR TST
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Owner/Contr:
NEXT INSPECTION 24 HOURS IN ADVANCE,
ARE FOR YOUR PERSONAL HEALTH <I SAFETY/
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CITY OF PRIOR LAKE
BUILDING PERMIT,
- TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
\, White
2. Pink
3. Yellow
File
City
AppliclUlt
Permit No.
9tf-J/t?9
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SIT~R1SEi
c e aSS tA Y\J .jj[A
~T
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S; f- 'PUD
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3, LEGAL DESCRIPTION
Z
12. NO. OF STORIES
LOT
BLOCK
PID ~-3(~- O:3q- 0
ADDITION
13. TYPE OF CONSTRUCTION
14.pWN.ER (Name)
W\LLI ArJ\.
15. ARCHITECT
6, BUILDER
(Name)
(Address)
(Tel 70,) ,. 8
-ft-il-i30o
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
:=r
(Name)
(Address)
(Tel. No.)
15, NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
7, TYPE OF WORK
New Construction 0
Fireplace D
Alterations 0
Septic 0
Addition 0
DeckLJ
Finish Attic 0
Re'roofin~ Porch 0
Re-siding 0 ~inish Basement 0
16, PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 190 PROPERTY DIMENSIONS' ~VERT SIZE
Sq. Ft. Width Depth I 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 all construction will conform to all existing state and local laws and will proceed in accordance with submitled plans. I am aware that the
bUildi\:1Illlhj1 CrlfVQke this perm'[r jusrcause. Fu~rmore, I hereby agree that the city official or a design.ee may enter upon the property to perfo~ n8Jrlie}tlnsp~o~.
X /I.. J. Y",.t'1J\v, \ _':1':::-.J..A{';Jf'-:;';-- 'f. ~ol '1- U-
Sig1'fi License No. Dale
17. COMPLETION DATI::
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
R'es~
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS [j'
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
PLANS & SPECS 0
SURVEY [j'
SETS
COPIES
'2..m~
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
Amount Brought Forward .................. <I:
Park Support Fee ........................... <t
SAC ......................................... <t
Collective Street Fee ............. .... ...... $
Sewer Tap ................................... $
$
7<1.7'
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... <I:
I. e..r
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ ~
Other ......................................... $
Total Due .............................. $- 76.c,rU
Pa;d '2' d7J ReceJeC'PI p. ..s" z..K '-
Issued
Dale "/3 0;" ., By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordj~ance and may proce~s 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.
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
City Planner
Date
Special Conditions n any
24 hour notice for all inspections 447-9850