HomeMy WebLinkAboutBuilding Permit 99-0972
DATE RECEIVED
6/ t1 jqC)
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.
qq...972-
,
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
2. J&~~~ -'- f71SCA At/~
~
8.9- q<i
,el
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
/ 0 BLOCK
lSleOOIC.S VI(,(.~6
PID ZS-6/fet... 03/ "'0
2 t:JIJ2 rtt:)O tV .
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER (Name)
D=~.J .~t41P
5. ARCHITECT - (Name) .
(Address)
~ -Ci A::1-~ 11Vf, 51
(Address)
(Tel. No.)
4410.. Z7?lJ
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction CJ
Chimney CJ Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Fireplace CJ
Alterations CJ
Septic CJ
Addition CJ
Deck CJ
Finish Attic CJ
Re-roofing CJ Porch CJ
Re-siding If Finish Basement CJ
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
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 property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
buildinq official can revoke this permit for just ca~e. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfoWLre~ inspections.
.x D -.- t!_ ~~ /' ~ 7"'79
--Signatur License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
CJ ENERGY DATA
CJ
1e6S /'tIle.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS CJ PERCOLATION TESTS CJ
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
PLANS & SPECS CJ
SURVEY CJ
SETS
COPIES
2. s-67J ~ CJ"V
PLOT PLAN
CJ
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Penalty ....................................... $
Plumbing Permit Fee ....................... $
CLOSE FILE
10/28/03 MP
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
. $
.$
.$
. $
. $
. $
City:
Division 1 2 3 4
7 +- '7S
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
J. z.. S'
Mechanical Permit Fee ..................... $
Sewer & Water Perm~ ...................... $
erm~ ..... ................. $
ng ~:trr;it w~jAf1fr7
Issued
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid "7". c/Z.. Receipt ~Ol
Date ~/q / qq By ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning OJnance and may proceedis requested. This document when
signed by the C~ Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
7~,(ft/
"3584+-
city Planner
Dale
Special Conditions ~ any
24 hour notice for all inspections 447-9850
ITT