HomeMy WebLinkAboutBuilding Permit #99-0267
~ RECEIVED .' CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
:CTIONS
~CES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
I S C') C( \-} , \, '\ ~ \ V\ \- ~ C)
3. LEGAL DESCRIPTION
l
LOT
1. White
2. Pink
3. Yellow
File
City
Applicant
C;C 2//)
Permit No. I 7 - l.1.
1. DATE
'-\ ~~l- qe}
BUILDING INFORMATION
, 11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
BLOCK
PID
~ - (){5 1- .r :0 s: ()
13. TYPE OF CONSTRUCTION
\
ADDITION
. .J. OWNER
-';;)-?-1
5. ARCHITECT
'\ ,r
t' \ I Ii' -
(Name)
it.( b4 Y'S k\/
(Name) I
(Address) l) A I
/5097 /iJant loft ~CK.
(Address)
'.G. BUILDER
"
(Name)
( ,
(Address)
(Tel. No.)
'Itf7~ 7o~7
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
~.
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofing 0 Porch 0
" New Construction 0:1 Alterati~s O. Addition 9 Fi~ish Attic O/""" Re-siding 0 Finish Basement 0
_ Chimney 0 MiSC.t~ p\r, ~~ \ \ U'j':... C: \/\ C..)\ t., fl~ 01\ \c..f~J D_~(
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 16~ CULVERT SIZE
· .Sq. Ft. Width Depth Yes No
~
SEATS
,t6. PROJECT COSTNALUE
)( ).. 1000
17. COMPLETION DATE
1-- ~
I hereby 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
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 off~ revoke t~s pe . or' st cause. urthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
y /~ .-c:!" / 'I.. ~~ 99
. 'Signature License No. Date
'-
.'
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
\6f: j-jJ r,.
v
FOR ADMINISTRATIVE USE
Front
Back
Side
I
)111(
{
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
.L< (y .x j . C) (' )
.
TYPE OF CONSTRUCTION: I II III IV (y)
Occupancy Group A B E F HIM R S
Division 1 2 3 4 !
Permit Fee ................................... $ { ,.,
o
City:
Plan Check Fee 00..0..0.00.... 0 0 0 0.. 0... 0 0 0 0 $
State Surcharge 0.. 0 0.. 0 0 0.. 0 0 0.. 0.. 0.... 0 0.. $
Penalty 00.. 0 0..00.. 0 0..0.....0... 0" 0 0 0 0" 0 00 0 $
q () . q Lfl
,0 C).
(1Jf(;/1 q ~
\j A/ ~ '. lit
1 i ),P,
,
Plumbing Permit Fee ...................... 0 $
Mechanical Permit Fee .. 0.... 0............'. $
Sewer & Water Permit 0:........ 0.. 0.... 0.. 0 $
Gas Firepl8<(e Permit, .. .. .. .. .. 0 .. .. 0 .. 0 .... $
This A9PI~rB'!Jmes Y:{rBuilding Permit When A~r~ved.
By 1./ !"'./ /~: Date (/. 7 -- I /
V . v./ " ,---,
'ficate of Occupancy
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
o COPIES
PLOT PLAN 0
Amount Brought Forward ....... 0.......... $
Park Support Fee o. 0 0.000000000... 0 0.. 0.. 0', $
SAC 000.......0.0.. 0 0 0 0 0.... 0.00000.0....00.. $
Collective Street Fee ... 0 .. 0.. 0....... ... 0.. $
Sewer Tap ......00000...0...0000000.00..... 0 0 $
$
Pressure Reducer 0.............. 0.......... $
Meter Horn 000.... 0 0 0 0 0 0 0.. 0 0.. 0... 0 0.. 0 0... o. $
Water Meter ....... 0.. .... .. .. .. 0.. 0.. 0 ..... 0 $
Sewer & Water Connection Fee o. o. 0 0 0 0 000 $
Water Tower Fee ............ 0.............. $
Water Tap 00000.. 0 0.. 0 0.. 00..' 0 0...... 0...... $
Builder's Deposit .. 0.. .... .. o. ........ 0 ...... $
Other ..................... 0.....0.......... 0.. $
I Total Due.. 0.... 0...................... $ / C 3 . 7 /
Paid ;'~ :"':'c) 03. . 7 I Receipt No. _' iT f. C; (;
Date 4 ~ 2-/(~ 0 By --( I (iii-~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning 6rdin~nce and may proceed as ~~~sted. This document when
Sign2!:~.f1~=emporary ce~{~e? Z.o~mPliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
~ ~it~~'anner ----. Date Special Conditions if any
24 hour notice for all inspections 447-9850