HomeMy WebLinkAboutBuilding Permit 00-0137
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicadt
Permit No.
~-f~ 1
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SlT.E ADDRESS I )
'G~it, /ui~ 1 ~..Q"~Aj ~~. -r.A #
1. OAT' /
-:::s/~ /00
~, E, 1:./50
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGA':flSSCRIPTION
LOT <-f' )l<OCK
ADDITION \ r fl-lc.te- >..-, tii
12. NO. OF STORIES
PID Z.L]-Of7-tYfl-o
13. TYPE OF CONSTRUCTION
4.0WNSR, (Name)
k&t (1.~,. '^~-:'\
5. ARCHITECT (Name)
(Address)
1~<i~'1 &:l.~I.l. ,~. S,~_
(Address)
(Tel. No)
IflJ~.zJJ7. S~~
(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 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
~ /
Re-roofing)( Porch 0
Re-siding 0 / ~ish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
)(
. ., u., "liS applic' hich is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
I conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
cause. t-U1111"""~ agree that the city official or a designee may enter upon the property to perform ne ed ins actions.
-- ~ S
I :---"'8 No.
SETBACKS: Required
Actual
CLOSE FILE
10/28/03 MP
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA CJ
Front
I
USE OF BUILDING --f~ 4-fP
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
2500 -
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
PERCOLATION TESTS 0
SETS
COPIES
BUILDING DEPARTMENT VALUATION
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee ................................... $
R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
'+~Il:)
\.' Z-~
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... ik.
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Issued
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid -r (;.., t / Receipt No.
Date ~/~/~ By ,Lo/f-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinan/e and may proceed as requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
, Cg
7~_
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Cny Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850