HomeMy WebLinkAboutBldg Permit 01-0446
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
c5--/(;=-o!
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
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I I
2.S'i#7J~~~ 6e
,
3. LEGAL DESC!!lPTION
LOT \.'""') BLOCK 5
- r9 rJlJ CMrt
ADDITION
PlDo;~-/38'- o3J-D
& CU~_) /.ftIC .
~ER1J.. ~A ~ }~ame) ~ I,M. ,.,....lAd~>S)
~. J(%U/t t.!tff.Ll U . ~
!';:.....RSi~TEyr/1. (N....) /"" ~ (Ad_'
~ ~~//J Aiu~u'>n..0~.f~(.<;
6. BUILDER (Name) f ~ (Address)
(Tel. No.) j
f!!;}-#7~f.HJ ,
(Tel. No.) . /
7b~ -39/ -J II If
(Tel. No.)
7. TYPE 01
lCkLJ
:ic CJ
Re-roofing LJ Porch LJ
Re-sidi~ Finish Basement LJ
New Constl
ChimneyLJ CLOSE FILE
8. PROPER 10/28/03 MP
Sq. Fl.
S
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit NOc21- () ~
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. PRO;): c~':UrJ
17. COMPU:TI~ bATE
I hereby ce.,.., __.. ._.~ .u...'",,,,,, ""UIII'lillun on tnlS 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 a 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
:uildlng official can revo this for ~urthennore. I hereby agree that the city offlcla'2]{JS!;;.;ra77r upon the property to perf~/;/Nons.
Ucense No. ( > Date
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... ~
Sewer Tap ................................... $
$
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Pennit Fee ..........~~~~~~...1...~...~..~... $ "/tl15"
City:
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
Mechanical Permit Fee ..................... ~.
t, ;;;.5'
SOIL TESTS
LJ ENERGY DATA
LJ
PILING LOGS LJ PERCOLATION TESTS LJ
PLANS & SPECS LJ SETS
SURVEY
PLOT PLAN
LJ COPIES
LJ
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... ~.
Water Tap ................................... $
Builder's Deposit ............................ $
Other......................................... $
Paid T07t; ~.OZJ.......~~~~i~;~o~c~~~f~
Issued Date 5-/ {; -() / BYCt.C./
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pr~ ;~uested. This document when
signed by the City Planner const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
Sewer & Water Pennlt ...................... $
Gas Fireplace Pennit ....................... $
This Application Becomes Your Building Pennit When Approved.
By Date
Certificate of Occupancy
City Planner
Date
Special Conditions n any
24 hour notice for all Inspections 447-9850