HomeMy WebLinkAboutBuilding #99-0263
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
r~~ TIONS .. AND UTILITY CONNECTION PERMIT
\ ES NUMBERED 1 THRU 17 MUST BE FILLED IN
B . FORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS r\_
f)?[)5 fy ();:f tV~ "1 t
r;=' so: 71:6~~';
~l'EH~ . I,
, .1 _ I
1. White
2. Pink
3. Yellow
File
City
Applicant
APR
2 1999
Permit No. c1'rl" -2(c3
1. DATE
L -2-C('\
Rt5D
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
LOT! 1'/1 (1 P I? {C)h1 BLOCK
ADDITION jl \\~, t-1f-> '( i1 r 11.,( l'Vi s
PID J5-Ck() .()f&-O
I.' i-r"2 {d ..' / P Q c.' I" \ E,' /' . . (I ,) I/:J3. TYPE OF CONSTRUCTION
./ I U IA.) ("1'" . (0 L. fU ,( 11'( IV'TO cD
12. NO. OF STORIES
4. OWNER (Name)
,"\ J1 " r: V {j' ;(
./ tI n (..f i... e,... ' . It/ ,,)
5. ARCHITECT (Name)
(Address)
,5]p :5
(Address)
F'l ''''If' '..
'r:.. (I ',~
(Tel. No.)
l~#"
(Tel. No.)
r:"(<( - SS''3\
(Tel. No.)
14. FLOOR AREA APPORTIONMENTUSE1
'''\
,.f
\,,).
,.e. BUILDER
'or
(Name)
)? if {Iv' ~.
(Address)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
,A';:\ ~
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
SEATS
16. PROJECT COSTNALUE
17~AT;..oOO
~. TYPE OF WORK r Fireplace ~
_---" ow Construction C'l' Alterations C'l
;.. himney 0 Misc.
8. PROPERTY AREA OR ACRES
lSq. Ft.
Septic 0
Addition 0
Deck,.
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
<t1frii!.
. ~ I hlfeby certify that I have furnished 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
~theabove mentione and that all c tion' nform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
'building offici n revoke this . urthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspectiOifs.
o -~ ~ --.- '~" j,. 99
\. ) ~ ~ ' Signature License No. . , Date
',,-_~' FOR ADMINISTRATIVE USE
..
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL !FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
.......
BUILDING DEPARTMENT VALUATION
i)
USE OF BUILDING t<J<.:; A t K
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
/':'-'0..
TYPE OF CONSTRUCTION: I II III IV (y/)
Occupancy Group A B E F HIM @ S U
. Division 1 2 (,3) 4
L/ LJ.)C-
Permit Fee ............................ ~. .. .... $ -::>
LU. .Cll
Plan Check Fee ............................. $
$ \.(\.()
State Surcharge .............................
(0 --2 .2t.:;
Penalty....................................... $
PERMIT VALUATION
--). oeo. 0 c.--;;
PLOT PLAN
o
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC .. . . . . . .. . .. . .. . . . .. . . .. . . . .. . .. . . .. . . . .. $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
- Plumbing Permit Fee ....................... $
"i:: ,c~\
\\ ,;'0
'-.. , l \
c\
Pressure Reducer .......................... $
.' Mechanical Permit Fee ..................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
~'.o
I \j;
. ""'" '. $ -l:rt'l,-treJ (\'\' v
.. - Gas Flre""fce,Pervut ....."................. ./ . c Water Tap ................................... $
ThiS.. A. p.~~. ~;..,.,'your Building Penn~ "Ir At>Pro~ Builde(~ Depos~ - nn n....n nn......_..._ $
BY//" '/1.I ',./'-':.,. Date '.' {j (/ Other ..~;...\.;;'.;...\.~.:...-,i3.;.:............. $ Ie) :?I.~CJ
(~cateofocCUp~ncy . TO~I,.D/~_.e. ...Cf...7.........n........:.... $ r.-, f".. I
b Pard L- -::>. Receipt No. U t,
~j Date //-(3 7-'1 By ~U j ---
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requestdJ. '. This ~ument when
signe~he City Po anner constitutes a temporary Certificate of ~9i~g compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
~~. L-I"~-T\
tJ . - - , C Y Planner Date Special Conditions if any
Sewer & Water Permit ...................... $
Water Tower Fee ........................,.. $
,;.'
\
24 hour notice for all inspections 447-9850
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