HomeMy WebLinkAboutBuilding Permit 99-0065
~,
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White
2. Pink
3. Yellow
File
Cily
Applicanl
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Permit No. '1 ~ - 00 b5
- 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 f\
Ho 3~ \ ..L TA SeA t-\\Jt:
3. LEGAL DESCRIPTION A
LOT P_o. C>u'tt1>r- . BLOCK I \ PIC
ADDITION r:;1"l.a?~,jt~ f-J:I~ 4~ A/>.f)
4. OWNE'h (Name),? \Add~e~) L-
\...-l-ry F')*- R\O'l( LA~
5. ARCHITECT (Name) (Address)
1. DATE
\-\~-qq
(2.-1
fl5 . 021 40~2;...0
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
(Tel. No.)
12. NO. OF STORIES \
13. TYPE OF CONSTRUCTI<j>N
"+\<<.b SPQIA )~l.Et'G~
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
6. BUILDER (Name)
G LA~Q.\:)\ Fw ~ ~'<: ~Qoc
(Address)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK /
New Construction g.'
Fireplace CJ
Alterations CJ
(Tel. No.)
9501 L,-\'O T\-\ ~\)'b.0~
S'\:AC.JJ 'Mtv. 550lCf ",,5'\-J..\lPl.-"n50
Septic CJ DetktJ Re-roofing CJ Porch CJ
Addition CJ Finish Attic CJ Re-siding CJ Finish Basement CJ
10. CULVERT SIZE
Yes No
SEATS
16. PROJECT COSTNALUE
\150,00
17. COMPLETION DATE
z,\ _ q q
Chimney CJ Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
I hereby certify that I have fumished infonnation on Ihis 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 confonn to all existing slate and local laws and will proceed in accordance with submitted plans. I am aware that the
builcJWll. official can r ke thi nnit for just cause. Furthennore. I hereby agree th'}l,the city official or a designee may enter upon the property to perfonn )l,eed~ i~pections.
X D NO, l..- 05 ~ \ - \~ - '1 '1
ignature - License No. Dale
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
FOR ADMINISTRATIVE USE .V_
~ MATERIAL FILED WITH APPLICATION
,- SOIL TESTS CJ ENERGY DATA CJ
\. \tor ;;:~:cs: ::OlATIONTESTS 0
o ~""VEY CJ COPIES
::t.I PLOT PLAN CJ
City:!o Amoun~ro ht Forward .................. $
\. 0 pa~p~rt Fee ........................... $
() '\: I"t. Q.~~.;.;:~;:;,;~;;"::::::::::::::::::::::::
~ ~ewerTap ................................... $
$
Side
SETBACKS: Required
Actual
Front
Back
USE OF BUILDING t4lh(....
Q./r.. - fl. (I(
I /
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I (u) III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
3'1. SO
Plan Check Fee ............................. $
State Surcharge ............................. $
Penally ....................................... $
Plumbing Pennit Fee ....................... $
..~o
Mechanical Pennil Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Conneclion Fee ........... $
Sewer & Water Pennit ...................... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other................. ........................ $
Paid Tot;I'~e~...,~.9.........~~~~i~;~0~ .~4~~o
Date 2f.o: -- By ~ lA--
This is to certify that the request in the above application and accompanying documents is in accordance with the CiIy Zoning Ordinance and may proceed as requested. This document when
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
Th ~~~;tr.~~;I~i~~.~.e:it When App-roved.
B ~ ~I'\ Date )-7.....\ ~7
Certificate of OccupanJ/
Issued
CiIy Planner
Date
Special Conditions W any
24 hour notice for all inspections 447-9850
111
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