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HomeMy WebLinkAboutDemo Permit 90-0007 ,..I~,\ f_j_.' ~,I C/o - t1tJo1 CITY OF PRIOR LAKE 1.=-.~ ~'OLntot-.l. IUlllllla PERMIT, 5:-S TEMPORARY CERTIFICATE OF ZONING COMPL~CE ft..ir _~.:.. AND UTILITY CONNECTION PERMIT '.rmff No. ' IAE SPACII NUMIERED 1 THAU 17 MUST IE FILLED IN BEFORE PERMIT IS ISSI.'ED (Pl.... Print or Type and "gn at bQttom 2. SITE ADORES 2.; Flr.plac.o Septic 0 H.atlngo Plumbing 0 ~.roofl"gO AIt.ratlonlo Ad:Sltlono Flnl.h ~.\tlco R..,dlngO M'IC.~ 10. CULVE~T SIZE V.. No I '*-by oertlly IIIllllIeft fumllNd '"fonnellon 011 flll'llIPllcellon wIllell I' 10 llIe lletf of m,.1l1lClWlMOt INllMd~. 1 ,Ito ",,11y 111.1 I em IIIe 0._ or IUlllorll" IOefll for 111.I tboft ,,*,11oMd I)IOtleI1y llIId .~..I ,n OOIIlIruotlon will OOIIfortll I.lIII..',,1fIO 1I111111l1 toollllWlllllll wln lI'OCMd In ~ willi IUllmltl" IIlllla, I "" IW_'"" IIIe bulld1no of 'I 0 "........ III' II for lUll 001III. 'unlltwmore. 11lIrItt( ""'111I1 llIe olty 'fftelll or ~ dll/OftM may IftIIr IIIIOft If" ".")CIItI,.lo pMortlI IIMCIIG '"Ipee. llonl. X ~ ~t)'\l \~q 0 o.t. CL"t R ADMINISTRA IVE USE 3. LEGAL t'lESCRIPTION \~ LOT BLOCIC.- ~eA.I~'~ I\%)DmON 4. OWNER Q~<:.~ "-\~ ~Ae.~ (Addr...) (l". N').) 1S. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS SEATS .e. ~STIMATED VALUE 17. COMPi.ETION DATE SETIACKS: .qulrld Actual '1'OIlt PROPOSED GRADe FOUNDATION IN.R~LATION TO '::URB OR CROWN OF STREET uSE OF IJUlbDIN.G 1\::'" ^^,~ :... '-"',,::,,~ ...... r___ . \ TYPE Oil CONSTRUCTION; i " III IV( Occupancy Group A 13 E I H~ DlYtIIon , ~ P.rm'tF.......................... .. ,__ PI.n Check.. 10 F.................. ... $ Slat. Burcharg. . . .. .. . .. . . . .. . .. . ... .. . Penalt). . . . . . . . . . . . .. ................ $ Septic Syit(jlm. . . . . . . . . . . . . . . . . . . . . . .. $ Other. . .... . . . . . . . . . . . . . . . . . . . . . .'. . . . .. ~ Subtotal. . . . . . . . . . . . . . . . . . . . . .. s. '. ..... I L SOIL TESTS P1UNO LOGS PLANS & SPECS ..... ..... ILE WITH APPI.ICATION o EN~RCJYDA'A 0 o PERCOLATION TEST 0 o SETS o COPIES /' I k<. OFF STREET PARKING____ SPACES REQ. SPACES ON PLAN SURVEY PERMIT VALUATION_ ^, IDc. PLOT P Amo~ht Forward............. S City: P'11e .. .~.,,;:................ s S.c..... rf:r~f.+................. $ Plumbing ........... .... ............ . Sewer T.p . . . . . . . . . . . . . . . . . . . . . . . . . .. i ~ Hook-up ....................... S Wat.r Hook.up . . . . . . . . . . . . . . . . . . . . . .. S Met" Hom . . . . . . . . . . . . . . . . . . . . . . . . . .. S Water Matl'...r "p,4.;,j ,.+........ $ Checl: if U Sew.r & Wat.r CG-diitla IO,n. Fee . . . . . .. $ '7 Oefer.t'~ r' Wat., Tow.r Fee ~~~ .1. . . .. .. . .. s -4. (y!\. ~ Wlt.r Tap. . . . . . . . . . . . . . . . . . . . . . . . . . .. . City F.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other .......6~.~.......... . Total DM; ...... .:...:...... ... ./'1"l) _ ^" Paid Receipt no. By Certificate of Occupancy IlIuld O.t. / /-: J ~ 0 0 I L-- Oat. By In tilt 10M IIIlIlIeMlOft IIld lOOOIIlWytna cIoeuINIntl II lit ~ wIItt IflI CII, Zol1IIIf 0rlIlllIIlII1Ild Ny"....,. ~ TtltI'" IMIr 00IIIt"1III IlIrIlOOfwy Cett.ne. of %oftt1lO 00IllPIlIII0I1Ild IIIOWI 00lltt1Ulltlon 10 _ ...... 0C0UNlI0Y. I Clltttfttllte Of 0lleuDIIwly I - -90 ~ "*'" ConcIttlOltllf "" Z. Hour notle. tor IIIIn1pectIonI U104D1 t:CIO ...... . 10:00 LIll. .' ~ I j I I .. . It'. .~,~ ...~