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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH AND SAFETYI
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Ij)J rg @ ~j13~-. CITY OF PRIOR LAKE
; i\\ I GltJ.19II5 .. i ~UILDING PERMIT,
/%l I! UI TEMPORARY crJl~TIFICATE OF ZONING COMPLIANCE
\-J AND U1'1~ITV CONNECTION PERMIT
! Permit No.
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
D..L III;' 177..,
-+y~
I
1. While
2. Pink
3. Yellow
File
City
Applicant
C; s-=- L./, er t..{
1. DATE
BUILDING INFORMATION
11, SIZE OF STRUCTURE
(Height) (WIdth) (Depth)
3. LEGAL DESCRIPTION
J
PID
sr
12. NO. OF STORIES
J
LOT aU 1"LoT It
ADDITION V /}/"" h IJ 0 , T I I'V
BLOCK
4. OWNER (Name)
'H 0/11 AS
(Address)
""., ()."'/T'T ~
(Address)
5. ARCHITECT
(Name)
6, BUILDER
(Name)
(Address)
7. TYPE OF WORK
New Construction 0
Fireplace l(
Alterations 0
Heating 0 Plumbing 0
Finish Attic 0 Residing 0
Septic 0
Addition 0
Chimney 0 Misc.
8, PROPERTY AREA OR ACRES
Sq. Ft. J 7 ,
13. TYPE OF CONSTRUCTION
(Tel. No.)
1.ItJ.J'& 0'
(Tel. No.)
14, FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. ESTIMATED VALUE
Rerooflng}l porchlJ'
Finish Basement 0
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
buil ing cial can revoke is per . or just cau ,Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X IO.OZ"l.qC
Signature License No, Date
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
Back
Side
PROPOSED GRADE FOUNDATION
IN RELATION TO C'{!: OR ~rN
OF STREET So
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS $!f' SETS
SURVEY d COPIES
"2., c.. . 5" c......
TYPE OF CONSTRUCTION: I 1\ III IV
Occupancy Group A BEl H ~ M
Division 1 ~ 4
Permit Fee ................................... $ I (D'2. . '2.~
Plan Checking Fee ......................... $ J 05 . if 7
State Surcharge ............................. $ t( , 80
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Subtotal............................... $ "2 '12 . 52--
City:
Check if
Deferred
This ~'!r ~mes YoJ Building Permit When Approved.
By ~~ ~ Date &t)- '2(, -.cr. ~
Certificate of Occupancy
Issued
PLOT PLAN
o
Amount Brought Forward . .. . . . ..... .. . .... $
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 ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Date B
'n the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed
ut s a temporary Certificate of Zoning C?om~ and allows construction to commence. Before occupancy, a Certificate
UJ-2'-.~
Date Special Conditions n arry
24 Hour notice for all inspections 447-42309:00 a.m. '10:00 a.m.
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White - Building
Canary - Engineering
Pink - Planning
Th. C.nt.r of lh. Lak. Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
/ I'~! . iJ
NAME OF APPLlCANT~.Jji (; I (t./ I Itl, (;. ,k L
APPLICATION RECEIVED I e/2 '1/1.5
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;-' Ii .. .- )
It92/ i-L X 'Liz::. l/'C-' {~I:;DJ ~~
Accepted
t/
Accepted With Corrections
Denied
Reviewed By: ~. M If J-li>EL I ~E:.I.t-
Date: IO/z.;z:/\99S-
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
Th. C.n.., of lh. Llk. Coun.ry
White . Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLlCANJ),~c-n'-lLu/ ~^1 ~,'J..L- >
APPLICATION RECEIVED /~/L;f/?j
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/t91-1 L1f~ a~t.,-
Accepted ~
Accepted With Corrections
Denied
Reviewed BY:{2.P~
Comments:
,. Mc:l......-k~"'- t"oo-;'~ O-::::t""J
Date: /()- 2~ - ez:.~
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
.r. . ~
White - Building
Canary - Engineering
Pink - Planning
Th. C.nt., of Ih. Llk. Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLlCANJk", aa/-J(./l ~td:~.k.L.-'
APPLICATION RECEIVED /~/2.Y/?5
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/t91/ /J:7j~ a.t~.
Accepted V Accepted With Corrections
Denied
Reviewed By: 1 ~
Comments: 11 m~,
Date: I()P7/t:6
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."