HomeMy WebLinkAboutBldg Permit 01-0338
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE AD9BESS I t... (J' /J .. ... --11 J. r
I ~ ~ 7 I .ALA (A ~ 9-' b(A}-t' 1/ tV
\.
BLOCK 3 PID ~-- jL/3- ()c:;o-o
-'kLI h /V1rJ.-- !) J.iMr
~ 0/
(AddreSS?~' II.. , fl. No.) C{ 5:), ....
fJ) 51J A O}{/lJ"\1l ~ 411 ~ ex 4 7 I
(Address) (reI. No.) 0 Iv' . :,
~ tJr/- 70 '1- &h'1
(Address) ./ (Tel. NO.~/teS
'1,1f Itpollo /y LISJ-{)IY
3. LEGAL DESCRIPTION
~t
LOT
ADDITION
b~~.~~~Qj
5. ARCHITECT v (Name)
6. BUILDER
(Name)
eU~m R~eJm
1. DATE
b-,/;J-61
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No./7/- ~::? t?
'-""
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
/
?
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofinli " _ Porch 0
New Construction 0 A b ~1~e\ati?ns.9, AdditiolJ,4!. Finish AW~ 0 ,~e:siding V Finish Basement 0
Chimney 0 Misc. ~~.{~. -':;{ ~ -~J.JA.IUU). f'
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE
Sq. Ft. Width Depth Yes No
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 !\('Id 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
building offi~an re o,ke t'\s pe~it !or iU.s~ fuse. Furthennore, I hereby agree that the ci~ offici~l a de~g~ may enter upon t~perty to perfo~ needewsP9Ctions'L
X y AI' .l\ ~h..trn ) ~:4 LI~ ! -, !:f-:{) t;l -- r d- - 0
Signature License No. Date
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Pennit ...................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA
PILING LOGS 0 PE~ION TESTS 0
PLANS & SPECS DE -
SURV 0 S
.. PLOT Q ,
e.........::::::::~V
:. I~.~;;;;;.;;tl!.:!::: v:
Sewer Tap .........,....................... $
Pressure Reducer .............~..
Meter Hom ..........................~. $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
FOR ADMINISTRATIVE USE
Back
Side
Side
17. COMPLETION DATE
o
SU 7)
71/. t=t)
Date
Special Conditions ff any
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
City:
........-
/".;25
Water Tower Fee ........................... $
Gas Fireplace Pennit ....................... $ Water Tap ................................... $
This Application Becomes Your Building Pennit When Approved. Builder's Deposit ............................ $
By Date Other ......................................... $ .-a--
Certificate of Occupancy Total~/.......O...................... $ ~ /t7.
Paid I ~ I tJ Receipt No.
~~ ~.
This is to certify that the request in the above application and accompanying documents is in accordance with the c~:;onit.~~1~e~~ may pr~ ~hiS document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
Crty Planner
24 hour notice for all inspections 447-9850