HomeMy WebLinkAboutBuilding Permit 00-0109
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY (;ERTIFICATE OF
ZONING C,.,PLlANCE
AND UTILITY CONf.iECTION PERMIT
nATF RFr.fIVFn
3/3/00
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FillED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign al bottom)
12. SITE ADDRESS
5-i--lt:~ (\,C:r,S,l\l-J"C{2A. ~~T. I,t. t j,IDI,- l.P..o(t
3. LEGAL DESCRIPTION
f,;
1. DATE
1Y1~
PUf)
LOT
I
PID /.-"'.-?Cf9- (;(~fo - 0
I s:r- AODN.
BLOCK
ADDITION
14. OWNE~ -..
-h, ~\
15. ARCHITECT
6. BUILDER
(,~RQLNAL..
k'fD6b'
(Name)
r'Vln,A
(Name)
(~~dr~ss) ~ I
"IlL' (,J r_""~h~kA .:.~~.
(Tel. No.)
221,: -'cLEf,
(Tel. No.)
M4\"k..
(Address)
(Name)
(Address)
(Tel. No.)
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 00- olOq
/
BUilDING ~NFORMATION
11. SIZE OF STRUSfTURE
(Height) (Wiyrh) (Depth)
12. NO. OF STOR'f
13. TYPE OF CONfRUCTION
14. FLOOR AREA TPORTIONMENT USE
I
I
15. NUMBER OF O~CUPANTS OR SEATS
OCCUPANTS 1
I
~. SEATS
7. IYPE OF WORK Fireplace 0 Septic 0 Deck 9l' RE!-roofing ['] Porch 0 I
New Gonstruction 0 Alterations 0 Addition 0 Finish Attic 0 Re-sidil1g 0 Finish Basement 0 16. PROJECT COjTNALUE
Chimi':lliY 0 Misc.
18. Pao,_~~ERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110 CULVERT SIZE 17. COMPLETION rATE
Sq. ~. Width Depth Yes No
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the OWl er or authorized agent for
tM'4ibove mentioned property and that all Construction will conform to all existing stale and local laws and will proceed in accordance with submitted ~ ans. I am aware that the
b!ln~!Dg..Q~~f.~~~IJtVo~ ~it for just cause. Furthermore, I hereby agree thai the dty official or a designee may enter upon the property to perto m~ded i, ......."'..."..... ,d.
~h .// ./'LL' .L;.~ f en
~ignature License No_ Date '
MATERIAL FilED ~ITH APPLICATION
Side SOil TESTS Cl E~ ERGY DATA Cl
PILING lOGS Cl PBRCOLA nON TESTS 0
PLANS & SPECS 0 SeTS
SURVEY Cl C( PIES
PLOT PLAN Cl
Amount BroJght Forward .................. $1
Park Support Fee .... .... ................... ,tl
SAC ......................................... ..1
Collective Street Fee .... ................... :t-I
Sewer Tap ................................... $1
$1
Pressure Reducer .......................... $1
Meter Horn ................................... :t-I
'. _ ~/ Water Meter ................................. .4'1
.1!W1 Sewer & Water Connection Fee ........... $1
Sewer & Water Permit ...................... $ t~ \ 0 W t T F <1:1
Gas Areplace Permit ....;1................ $ '3'\1'\ 0 w:t:;T:;e.r....~..:::::::::::::::::::::::::::.1
This~'J9,~m~our Building Permit When Approved. Builders Deposit ............................ .1
0' By ~ Date ? <:- IrQ-:, Other ......................................... $1
. erti'icate 01 Occupancy Total Due .........t.j..................... .11 124-. 64-
. Paid /7 4. 0 ReceiPt~/;; ..s & J to &
f! Issued Date .3/1 "':/IJ U By J1..h1( __
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordina'nce and may proceed if!..eqtted. This document when
Sig~,m gity flflne~ constitutes ~ temporary Certificate of Zoning compliance an ,allOWS constru~on to com~ce. Befo, re occupancy, a Certificate of Oc pancy must be issued.
~>>- ~ <.. "t. ex:> . jt' ~ )",;<....:;{u
<, ' C~y Planner Dale Special Conditions if any I
-J-
l
FOR ADMINlISTRATIVE USE
"'~
SEaAC~S: Required
Actual
Fronl
Back
Side
<I BUILDING DEPARTMENT VALUATION
/ US.E OF BUI\-ll!NG
rcP:. Jj If(
I
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION . tJ( Vi. Clr.;;
TYPE OF CONSTRUcnON: I 11 III IV
Occupancy Group A B E F H; I M
Division 1 2 3 '4
V
R S U
City:
il 'I "I')
LI,9,,<';'j
I . So
Permit Fee ...............................~-... $
,
PI~n Check Fee ............. ................ $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
24 hour notice for all inspections 447-9850
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