HomeMy WebLinkAboutBuilding Permit 94-0437 �'-------`—_'_._._ _ _ ,
�� PR � O '� ��; ���� l� CITY OF PRIOR LAKE i. wn�« F�ie
.. f ------ 2. Pink City
� � BUILDING PERMIT 3. Yellow Applicant
=' �' ° S��ll�d�i4►RY CERTIFICATE OF ZONING COMPLIANCE
�.' AN ' '�'ILIN CONNECTION PERMIT R � , /3 �
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Permit No.
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN n/ �� i/
BEFORE PERMIT IS ISSUED (Piease Print or Type and sign at bottom) �! 7 BUILDING INFORMATION
2. SITE ADDRESS �,/ � 11. SIZE OF STRUCTURE
/ L�7� L'L �G /�/G, 12 ��I�� /'IiV �.J��,3� �Height) �idth) (DePth)
3. LEGAL DESCRIPTION ��' 12. NO. OF STORIES
LOT �' BLOCK ,� PID r�, I�� OO� � �-��
A � N � / � ,/ 13. TYPE OF CONSTRUCTION
ADDITION �t"CIV��� \� � T�Q/t
4. WNER e) • (Address) (Tel. No.) 14. FLOOR AREA APPORTIONMENT USE
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5. �C I�ECT � ,j(Ja //�� ��, I (Address) �� A' (Tel._No.) � (��
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6. BUILDER (Name) (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS O�i SEATS
� .��y�� OCCUPANTS S
7. TYPE OF WORK Fireplace p Septic p Heating p Plumbing p Reroofing O Porch p SEATS
Aiterations p Addition p Finish Attic p Residing p Fin� 16. E IMATED VALUE
Chimney p Mi . t ' �. � �" � O ��
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS . CULVERT SIZE 17. COMPL TION DATE
Sq. Ft. Width Depth Yes No
I hereby certity that I have furnished information on this application which is to the best of my knowledge true and correct. 1 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
building ofiftCial caryr6voke ihis pe�mit for just cause. Furthermore�'(ereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ; ! l.,.�_.- /d� f /i . �- . - %; i �l�'�C�� �C?�'
Signatur ! License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required MATERIAL FILED WITH APPLICATION
Actual SOILTESTS � ENERGYDATA p
Front Back Side Side
PROPOSED GRADE FOUNDATION OFF STREET PARKING PILING LOGS p PERCOLATION TESTS p
IN RELATION TO CURB OR CROWN PLANS & SPECS p SETS
OF STREET SPACES REQ.
USE OF BUILDING SPACES ON PLAN SURVEY O COPIES
) �evlci. �.�.; s�-.
PERMIT VALUATION S PLOT PLAN O
TYPE OF CONSTRUCTION: I II III IV�V Amount Brou ht Forvvard $ ��,C ��• � S
City: 9 ..................
Occupancy Group A� E I H R M Park Support Fee ........................... $
Division 1(�3 a SAC ......................................... $
Permit Fee ................................... $ t a� • � � Collective Street Fee ....................... S
Plan Checkin Fee $ �� Sewer Tap ................................... $
g.........................
� License Check Fee ......................... $
State Surcharge ............................. $ b• 2 S
Pressure Reducer .......................... $
Penaity....................................... $ Meter Horn ................................... $
Septic System ............................... $ Water Meter ................................. $
Check if O Sewer & Water Connection Fee ........... $
Other......................................... $
S Deferred p Water Tower Fee ........................... $
Subtotal ............................... $ � � � • 1
WaterTap ................................... $
This icati Becomes Your Building Permit When Approved. Builder's Deposit ............................ $
ByDate �_�� Other ......................................... $
Total Due .............................. $ � .
Certificate of Occupancy
Paid � /� Recei t No. � .
Issued �
Date �G� � B
This' o certify tha in the above application and accompanying dxuments is in accordance with the City Zoning Ordinance and may proceed a equested. This document when
si ed City r c itutes a temporary Cert�c o ni co pliance and allows constru ' n to co ence. Before occupa a Cert�cate Oc upa cy must i ued.
�-�- e `����,�. ��.; � � �?- a��
G Planner Date Special Con L ns if any
24 Hour notice for all inspections 447-4230 9:00 a.m. • 10:00 a.m.
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�F PRIp
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White - Building
Canary - Engineering
Pink - Planning
Tbe Cen�er of Ihe I,ake Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
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NAME OF APPLICANT f�� � ' �;-�
APPLICATION RECEIVED �`��' ����
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I ��� � �� !1`�-�-, . ,;,:� ;; � ,� _ l_� �--C..� % �-
y
Accepted � Accepted With Corrections
Denied �
Reviewed By: Date: � C� -"
Comments:
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;
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."