HomeMy WebLinkAboutBuilding Permit (Roof) 95-0204
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL TH AND SAFETY!
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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 revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
1, DATE
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 I \
~~ \....f'....Jl~ ~.~~ C28.\~
3. LEGAL DESCRIPTION
..s:=- I CJ -0-5:
PID 2;:-ct:3J....;:- ~ ~ ~
LOT
ADDITION
4. OWNER
BLOCK
(Address)
~ ~~~
dAddress)
~l.c- .:r:-~ \..
pAdd~e~
(Tel. No.)
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Reroofing 0 Porch 0
Finish Basement 0
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
Signature
Ucense No,
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Back
Side
Side
Front
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET po.
USE OF BUILDING (<k.-(L~'r.....
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
'2 Y ..1'1 f) ::::.:-
1. While
2. Pink
3. Yellow
File
City
Applicant
Permit No.
q';:--2~4
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (WIdth) (Depth)
12. NO. OF STORIES
1~P~ OF CONS~CTIO~
r~lI'p,. \ l~~
14. FLOOR AREA APPORTIONMENT USE
"..-
.:::::,.
Date
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS.;;L SETS
SURVEY 0 COPIES .-1-
PLOT PLAN 0
TYPE OF CONSTRUCTION: I([)IIIV
Occupancy Group A Be[} H R M
Dlvlsio(l) 3 4
p,,.. '00 .... .... .......... .......... ........ .'Z r - 'I ~
z ,-- '........
Plan Checking Fee ......................... $ ~ I (
State Surcharge ............................. $ I t (:)1
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Subtotal. ............................. $ ~CJ - ~?
Amount Brought Forward .................. $ <:::: 'S: a - :::;",-'){
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn..... ..................... ......... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o Water Tower Fee ........................... $
City:
Check if
Deferred
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid . Jl
Date 1. K3 r;-
By
om Your Building Permit ~en Approved. ,.-
Date k-\. ~..-q ~
Certificate of Occupancy
Issued
B
in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed
ut a temporary Ce~ate of ~i~m~ and allows construction to commence. Before occupancy, a Certificate
b --!-- "S;;7-~
Date Special Conditions ~ any
24 Hour notice for all inspections 447-4230 9:00 a.m. . 10:00 a,m.
q~r-2o i