HomeMy WebLinkAboutBuilding Permit 00-0188
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White
2. Pink
3. Yellow
File
City
Applicant
Permit No. (J{J-/88
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DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEfORE PERMIT lS ISSUED (Please Print or Type and sign at bottom)
2':1t~G ,C::;POYl 0
3. LEGAL DESCRIPTION U
LOT .~ 4- BLOCK
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f1~~Y" fl/LIl...h
(Name)
1. DATE
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,
PID ZS -/3/-(jIB-4-1
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13. TYPE OF CONSTRUCTION
ADDITION
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5. ARCHITECT
6. BUILDER
LJI Ie"€-_
BUI~INFORMATION
11. SIZE OF. UCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
(Name)
(.T el. NO')~' 14. FLOOR AREA APPORTiONMENT USE
" f/,J-1Y7- zt, _ '?
(Tel. No.)
(Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
(Address)
J A~'V\ 'e_
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
- 8. PROPERTY AREA OR ACRES /9, PROPERTY DIMENSIONS /10, CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certijy thet I have IUmish 'nlom,alion on this application which is to the bes, ot my knowledge lrue and correct. I also certify that I am the owner or authonzed agenl lor
the above mentioned property an at all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
~Uildi ic' I c ,eVOkj{ pi' ..--: Funherrno'e, I he,eby ag,ee tha' the city official m a designee may enter upon Ihe property 10 p_erlOq:,ed~~~ .
l:ignalure License No. Date
SETBACKS: Required
Actual
Fireplace D
Alterations D
SEATS
Septic D
Addition D
Deck LJ
Finish Attic LJ
Re.roofin% Porch LJ
Re-siding 0 Finish Basement 0
16. PROJECT COSTNALUE
17. COMPLETION DATE
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- - -- -
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
SOIL TESTS Cl ENERGY DATA Cl
PILING LOGS D
PLANS & SPECS 0
SURVEY
Front
Back
Side
~ide
USE OF BUILDING
BUilDING DEPARTMENT VALUATION
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OFF STREET PARKING
SPACES REO
SPACES ON PLAN
PERMIT VALVA TION
2. {(51) _ CIV
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM A
Division 1 2 3 4
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City:
Permit Fee ................................... $
74.3r-
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
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Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
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By '3t 'lJ1JZ1 Dale -;Pf5lii V
Certificate of OccJpancl -
Issued
City Planner
Paid
Date
Dale
Special Conditions if any
24 hour notice for all inspections 447-9850