HomeMy WebLinkAboutBuilding Permit 99-1369
a.BUILDER (Name) (Address) ~e~ro~776b<y
7. TYPE~~!Rr" I () 1i~lacet'q~e~~ "'I DeCk~d6S~'~I~: m e~;D!:'7:>'111
New Construction 0 Alterations 0 Addition 0 Finish Anic 0 Re-siding 0 Finish Basement 0
ChimneyO Misc. ~ft ~n IA} ~ If\fh~ HoJ.l \1 OMlIO A'
lB. PROPERTY AREA OR ACRES 190 PROPERTY -O"IMENSioNS 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 all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
~ ~fficial can~r yoke ...this pe~t fOf just cause. Furthermore, I hereby agree that the city official Of a designee may enter upon the property to perfonn needed inspeQtion$.
lli,;ll1W\ . _~.!b JI'''' oJ JI-~. -9f-
Signature - License No. Date
Amount Brou ht F 1'~""" $
Park Suppo ......... ..I'..... $
SAC .. .....l:! ............... $
~Oll t Fee .................. $
e p ......1......................
ressu~r .......... ..............:
eterH""!C,, \, .............. ·
Water Meter ... ... ................... '*'
Sewer & Water Con on Fee ........... '*'
WaterTowerFee ........................... It
S~1
,~7;;71Cj
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
';;?Z Z If9
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SrTE tz:Os 7 7
3. LEGAL DESCRIPTION
(.{d
n () r th Lt) CX'"'f1
.e / 5.0
BLOCK
/VOR7HWOOn
4. OWNER (Na~ ~.>A? ,,1
PAS S o 1-"77 IC-G/
PID
z5 - !.!11.:::./JtS -0
LOT
ADDITION
(Address)
(Tel. No.)
5. ARCHITECT
(Name)
(Address)
(Tel. No.)
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Side
Front
Back:
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
zm.uV
USE OF BUILDING
~ -o/'.e-
TYPE DF CONSTRUCTION' I 11 111 IV V
Occupancy Group A B E F HIM R S U
City:
Division 1 2 3 4
Permit Fee ................................... $
7'-1 7"--
Plan Check Fee ..................... ........ $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
J.2-\
Mechanical Permit Fee ..................... $
Sewer & WaterPennit ...................... $
1. White
2. Pink
3. Yellow
File
City
AppUcant
Permit No.
CfCJ- / 3(p Cj
,
BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS ~ PERCOLATION TESTS LI
PLANS&O SETS
SURVEY COPIES
TPL 0
B""~ ~/~i~~i:t;itW}jti"'i7q3- :~:~~~~~~~~it:.:.:.:.:.:.:.::::::::::::::: :
CertlflcateofOccupan~ / Total Due .............................. $ 7fd.O 0
Issued P.,d 7(",. 0 0 Rece~PI ;-r-=3fo 5 ':I .5
Date II/ZZ/ttC, By ::;{.-
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 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.
C~yPlanner
Dale
Special Conditions if any
24 hour notice for all inspections 447~9850