HomeMy WebLinkAboutBuilding Permit 00-0150
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
~ORE PERMIT IS ISSUED (PleaSe Print or Type and sign at bottom)
, ~'TE ADDRESS /1 . ,
/ ~5"S-O 51~C( /"11 ( f'V-...
3. LEGAL DESCRIPTION
LOT I 'I - BLOCK
ADDITION T...IL ~ v,'J>.' 1st
~
t z?YPE OF WORK
New Construction 0
Chimney 0 Misc.
B. PROPERlY AREA OR ACRES \9. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yas No
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. , also certify that I am the owner or authorized agent for
tile above mention roperty d I 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 c 0 i armi 0 j e. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
( ~NERI
-::JO-e
5. ARCHITECT
~
(Namrm
( ~ILDER
,
(Name)
3i;~~
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
';7.rL/ /00
Z-
1\J.o ..
PID 2<:"_lo.t:;'_D'lA-/'J
(Address)
c::... 0_
(Address)
(Tel. No.)
(Tel. No.)
(Address)
(Tel. No.1
~
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
x
License No.
\ /
SETBACKS: 'l'fequired
Actual
BUILDING DEPARTMENT VALUATION
USE OF ~LDING ~
DO, 1}/f2..
I
Amount Brought Forward ..................1\".
ParkSupportFee ........................... $
...... $
r ~"......$
t-L \~~ ~C;r.......:
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
t; 00 9L
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee .................
Plan Check Fee ............
State Surcharge ............
Penalty ......................
Plumbing Permit Fee ......
Mechanical Permit Fee ....
Sewer & Water Permit .....,
Issued
This is to certify that the requ~
signed by the City Planner con
S U
City:
- -
~.
C \05<2-
w
/,/
:.)
i \
( ()
"titt.,"""
1. Wrote
2. Pink
3. Yellow
File
City
Applicant
Permit No. ~D - b ,. c:;o
BUILDING IIiIl'ORMA TION
11 . SIZE OF ST....Jll.... I RE
(Height) 'tIIiil- (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
i Date)
I MATERIAL FILED WITH APPLICATION
SOIL TESTS LI ENERGY DATA LI
PILING LOGS a PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
LI COPIES
LI
..... $
:c I .If ~<<.~~~~ .....:
II \A.l1J... W, t-V'-- "0 . /--.....
t-erfM.I.\ ..... $
.....4'.
(tP
..... $
.... $
.... $~/ <:V
llNo.37/o3
fIlL--
; requested. This document when
f Occupancy must be issued.
CilyPlanner
24 hoUr notice for all inspections 447-9850
Special Conditions il any
Date
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