HomeMy WebLinkAboutBuilding Permit 00-0244
~~
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
.
Permit No.
OD -D21A
I
I
(Depth)
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
S("")()11 r:o.....vi-e.w ~
3. LEGAL DESCRIPTION
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTuRE
(Height) (Width)
LOT "2 "
12. NO. OF STORIES
BLOCK
PID 25'""- 132.- 0"- 0
ADDITION Fc:H\.....\I(.~} ~k
13. TYPE OF CONSTRUCTION
4. OWNER
Atl.out
5. ARCHITECT
(Name)
r..,Id............
(Name)
(Address)
'i>'--'t
(Address)
(Tel. No.)
'1<< -~,IJ/)
(Tel. NoS
, 14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
, 15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
<;~
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations D
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofin~ Porch 0
Re-siding 0 Finish Basement D
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES /9. PROPERTY DIMENSIONS /10. 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 menti ed pro ~ t t all construction will conform to aU existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building off' n vo 's i for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorm needed inspections.
X '1-/3-~oc)
'" --. . -
Signature License No. Date
17. COMPLETION DATE
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDIN)'.
fb2....
,
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION ~,.,CO. 00
~
.
PLANS & SPECS 0
SURVEY
SETS
,,0\
Sewer & Water Permit ...................... $
';;}:i;f.~;;;.~tn"o
Certificate of OccuPancy
Aj~
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:
7tf."'}c::;-
Plan Check Fee ............................. $
1."2.< II' \1-
~
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
1~ .00
CnyPlanner
Dale
Special Conditions if any
24 hour notice for all inspections 447-9850