HomeMy WebLinkAboutBuilding Permit 00-0360
PRI -::W 0 I J.f~
~~ s ;~~/:O
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FillED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
5-1 It; ~(X)
2. SITE ADDRESS
I ~t 0 I S
H iCU1/('J yyJ A ~ /U,W,
u
3. lEGAL DESCRIPTION
II
BLOCK RID 61S-L43-(\IJ- ()
\ ....\I1~ \1--\L'l1 \c;.+ A111)N
4.A~NER (Name) (Address) IA ~.j ../1 (Tel. No.) )
ffJlkL l)ploh-Rry.. 1'!5t1J15 J.lJi'-1)rpl0 An;. "u,lj
150 ARCHITECT (Name) (Addre ) (Tel. No.)
6. BUILDER. (Name) , (Address) I ^(.... 8el. NO.eoqC:::p\
A~t3~ tYtHCtrQ. d(JVJ \Y ",..-[ (-
/dr}.<-f' II J ICD/ let 4t-f. S. ~ll..rry.:Ntll~, f.lliL~iO"~?\1
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 "Re'roofin~ Porch 0
New Construction 0 Alterations 0 Addition 0 finish Attic 0 Re-siding 0 Finish Basement 0
LOT
ADDITION
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES
Sq Ft .91.oJ::x
L White
2. Pink
3. Yellow
File
City
Applicant
Permit No.JJD - 031,0
BUilDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width)
(Ooplh)
12. NO. OF STORIES
13. TYPE OF COI)f3TRUCTION
(-ef/(trf
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16)'ROJECT COSTNAlUE
, S-;Oe(!-
17. COMPLETION DATE
19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Width Depth Yes No
I hereby certify that I have fumished 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 prop€! a hat all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
:1 ff' I a r is,' o()f\Si)urthermore,lherebyagrf:1l)le([f.}f~a83deSjgneemayenteruPOnthepropertyto60...ibed~DOactions.
Signature --1)" ... License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Saok
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
.
USE OF BUILDING t1
VO<:'
MIL
,.
TYPE OF CONSTRUCTION: I JI III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Permit Fee ................................... $
'"II./. '1"
Plan Check Fee ...................... ....... $
State Surcharge ............................. $
Penalty .................. ..................... $
I.as
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Pennit ...................... $
GaS~FirePlace Pennit . ..................... $
Thi Ii ion ~s 0 r uilding perm~' ro d.
By Dare
'-
Certificate of Occupancy
MATERIAL FilED WITH APPLICATION
SOil TESTS 0 ENERGY DATA 0
PILING LOGS a PERCOLATION TESTS a
o
o
o
Other ..........................................It
Total Due .............................. $ '7 t.. 0{)
pald'7h <JO Receipt No. ~ 14 Lf 8'
Issued Date s117/Un By ~i
This is to certify that the request in the above application and accompanying documents is in accordanCe with the City Zoning b~~d may proceed a uested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows coostruction to commence. Before occupancy, a Certificate f pancy must be issued.
City Planner Dale Special Conditions if any
24 hour notice lor all inspections 447-9850