HomeMy WebLinkAboutBuilding Permit #03-1242
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DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT, ,. ",
TEMPORARY CERTIFICATE OF <\t r719 . CO
ZONING COMPLIANCE .u
AND UTILITY CONNECTION PERMIT Permit No.
L White
2. Pink
3. Yellow
File
City
Applicant
qq. /242-
~CTIONS
CES NUMBERED 1 THRU 17 MUST BE FILLED IN
_...:fORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
8':::Y:?to C) C>\ . \ i \C~) L un ~c~
3. LEGAL DESCRIPTION
1. DATE
i '-i
I '
(*
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
-. \ l
J..A,....
)~ ICD
..\,\
5. ARCHITECT
v':.
(Address)
j , ,11 t/\(1.1' j
(Address)' .,J
\~
"j '(Address) vr' I(jv, lIe.
filN
k'd '::J5?3-/
Re'roofin9}'. Porch 0
Re'siding 0 Finish Basement 0
(Tel. No.)
" f"'i.',
IJ'l::J LV
(Tel. No.)
l...( if.
.Q,Cf ({V~
12. NO. OF STORIES
1
...I-
13. TYPE OF CONSTRUCTION
~,.,'"j<J 1.)'(...-'
14. FLOOR AREA APPORTIONMENT USE
LOT
BLOCK
{I(IES . !5C..UlvU'S
(Name)
I 'j'.."
r L \,,\ '~.1:
(Name)
PID 25-/33 - (4t - 0
ADDITION
4. OWNER
r
6. BUILDER
(Name)
rr eCNo.) i lP \ ',.)
\ I ~,,('1
15. NUME3ER OF OCC:UPANTSOR SEATS
OCCUPANTS
I',
I" i,/J\/~.j C('cb(l Ii'll rt'l ([)f
7. TYPE OF WORK Fireplace 0
New Construction 0 Alterations 0
L-t):
t-, \ \ \ \
Deck 0
Finish Attic 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
SEATS
16. PROJECT COSTNALUE
~ I i 'I F"v'-~ (!:::.
1-1 I \..h-......
17. COMPLETION DATE
Septic 0
Addition 0
I hereby certify that I have fumished infonnation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
the above mentioned property and that all construction will confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUild~ official can r~oke this pennit for just cause. Furthermore, I hereby agree '!J~t t~e cityofficill~or a designee may enter upon the property to perionn needed inspections.
X \ ILlJ ()l U?1 )'L-JU :>iU \ \n~ \ D 1-71Cf1
"9 Signature License No. Oat
FOR ADMINISTRATIVE USE
SETBACKS: Require.d
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
J"; C '-: f\)')
1<... L> f--
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 .PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
- v.::>c: vF BUILDING
.
PLANS & SPECS 0 .SETS
SURVEY 0 -COPIES
2 '-::::.....DZ). Cll)
PLOT PLAN
o ..
TYPE OF CQNSTRUCTlON: I II III IV V
Occupancy Group A. B E F HIM R S; U
Division 1 2 3 4
City:
~:::::::::::::::::
Collective Street Fee ....................... $
SewerTap ................................... $
$
"',(
Permit Fee ................................... $
74. Ie:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
Mechanical Pennit Fee ..................... $
,. (: r;-
Pressure Reducer .......................... $
Wleter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Sewer & Water Pennit ...................... $
Water Tower Fee ........................... $
Gas Fireplace Pennit ,.. ..~.................. $ Water Tap ................................... $
ThiS~On BecimA, . ~,/: Building Penni! W~erf App!qiJ~r Builder's Deposit ............................ $
By , " '. T' ",/-':, "./' Date ! 1.'// :>/', I Other ......................................... $
I ,/ I "'71>' ( 0
-~rtificate of Occupaniy Total Due .............................. $
d Paid -7(( ,(j () ReceiptN9, :~'S (C"4 2 J
Date / () / I ~/ '1 'i By Jltl_
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning 'Ordinince and may proceed aY,eqUested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificatefu Occupancy must be issued.
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447...9850
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