HomeMy WebLinkAboutBuilding Permit 00-0006
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
11o'~
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
(){) - rJ(JQ/o
CTIONS
.:ES NUMBERED 1 THRU 17 MUST BE FILLED IN
beFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
LJ)3L/ Colur-eu/a sl-- S.e-:
3. LEGAL DESCRIPTION
1. DATE
J- LJ - q 9
IC ( J;,-D
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
ADDITION
4. OWNER (Name)
\)~\L- C hn.J""6
5. ARCHITECT (Name)
BLOCK
PID ~S; -~~-O S';>- z..
13. TYPE OF CONSTRUCTION
(Address)
4) 3 4- CD/"rar/O
(Address)
(Tel. No.)
S+-. ~.
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
~(e- C-),q rof
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Lf I 3 '-/ Cv~r4r/ 0 S -1-. S e-
Septic 0 Deck 0 Re-roofing 0 Porch 0
Addition 0 Finish Attic 0 Re-sid~ Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
B. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMr-Lt: .ION 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 menti ed 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 offici revoke th!a permit for just Clf1'e. Furthermore, I hereby agree that thllcity official or a designee may enter upon the property to perform nee?e~ inspections.
X L f?;jJ~ ~.J ~ ~ D \..., ..s- ~31o /- "1- 99
Signature License No. Dete
dACKS: Required
Actual
Front
Back
CLOSE FILE
10/28/03 MP
,TERIAL FILED WITH APPLICATION
,STS 0 ENERGY DATA 0
LOGS D PERCOLATION TESTS D
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
leB H'/J2-
,
OFF STRI
SPACES f
SPACES ON PLAN
PERMIT VALUATION
A SPECS D
SURVEY D
SETS
COPIES
"2...>6)) . nJ
PLOT PLAN
D
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
/'f- 1)"
Plan Check Fee ............. ................ $
State Surcharge............................. $
I- "- )"
Penalty ....................................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid ,'', () 0 Receipt
.-Ied
. Date 1('\(6() By
.~ is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordi ance and may proceed requested. This document when
signed by the City Planner constitutes a .~"''''''v, "ry Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
G~S Fire~! e ptrmitF... .................. $
Thi r tion eco ur Building Permit Wh?nj~ved.
B Date~{l
Certificate of Jcupa cy
-7(,.00
~ t, 73 I
C~y Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850