HomeMy WebLinkAboutBuilding Permit 98-1483 �OF pR ��'Q� DATE RECEIVED �
CITY OF PRIOR LAKE � �. w��e File
v ��.x,., BUILDING PERMIT, � � z. r�� c��
, „ 3. Yellow Applicant
���; –2 , TEMPORARY CERTIFICATE OF �
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT Permit No. 9� �5��
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUS7 BE FILLED IN /�/� f��
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) �c7` � BUILDING INFORMATION
2. SITE ADDRESS 11. SIZE OF STRUCTURE
� � /�� (Height) (V1lidth) (Depth)
3. LEGAL DESCRIPTION 12. NO.OF STORIES
LOT � BLOCK PID��^' I'
A 13. TYPE OF CONSTRUCTION
ADDITION � � � X �+✓
4. OWNER Name (Address) (Tel. No.) 14. FLOOR AREA APPORTIONMENT USE
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5. ARCHITECT (Name) (Address) (Tel. No.)
6. BUILDER (Name) (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
���i'�� OCCUPANTS
��l¢,r,r�s''� �o � �s� u�a����- '�� -3 y
7. TYPE OF WORK irepla O Septic O Deck O Re-roofin Porch O SEATS
New Construction O Alterations O Addition O Finish Attic O Re-siding O Finish Basement O 16. PROJECT COSTNALUE
Chimney O Misc.
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17. COMPLETION DATE
Sq. Ft. Width Depth Yes No
I hereby cert'rfy that I have fumished infortnation on this application which is to the best of my knowledge true and correc.t. 1 also certify t 1 am the owner or authorized agent for
the above mendoned propeRy and that all construction will conform to all existing state and local laws and will prxead in accordan submitted plans. 1 am aware that the
building official can revoke this permit for just use. Furthermore, I hereby agree that the city official or a designee may enter u to perfo►m needed inspecUons.
X ,� D�._��� �— /a/�/QA-
s�y�em�e ��ns. �au
FOR ADMINISTRATIVE
SETBACKS: Required � L FlLED WITH APPLICATION
Actual L STS O ENERGY DATA D
Front Back Side
BUILDING DEPARTMENT VALUATION OFF STREET PAR NG LOGS O PERCOLATION TESTS O
SPACES REQ. ' PLANS & SPECS O SETS
USE OF BUILDING
SPACES ON PLA y SURVEY O COPIES
PERMIT VALUATION �,.7 U U• ,�,v PLOT PLAN O
TYPE OF CONSTRUCTION: I II III IV V Q
Occupancy Group A B E F H I M R S U Amount Brought Forvvard .................. $ .
Division t 2 3 4 ./ Park Support Fee ........................... $
PertnitFee ................................... $ � �' �3 SAC ......................................... $
Plan Check Fee $ Coliective Street Fee ....................... $
.............................
� r Sewer Tap ................................... $
State Surcharge ............................. $ / - L.7
$
Penatty ....................................... $ Pressure Reducer $
Plurr�in Pertnft Fee $ Meter Hom ................................... $
g .......................
Mechanical Pertnit Fee $ Water Meter ................................. $
Sewer & Water ConnecGion Fee ........... $
Sewer & Water Permit ...................... $ Water Tower Fee $
Gas Fireplace Pertnit ....................... $ Water Tap ................................... $
Triis Applicatlon Becomes Your Building Pertnit When Approved. Builder's Deposit ............................ $
By Date Other ...................................
......
Certfficate of Occupancy Totat Due .............................. $ ��. d
Paid , QO Receipt No.� ��
Issued
Date � By
This is to certiTy that the request in the above application and accompanying doaiments is in accordance with the City Zoning Ordinance and may proceed as uested. This docum�t when
signed by the City Planner cwnstitutes a temporary Certificate of Zoning compliance and aAows construction to commence. Before occupancy, a Certif'�cate of pency must be issued.
City Planner Date Special Condftions'rf any
24 hour notice for all inspections 447-9850 /%� /��
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