HomeMy WebLinkAboutBldg Permit 01-0482
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
C DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
IS'-l~:t. ~~h Vn\V'\\- 11..d}~:>.~
3. LEGAL DESCRIPTION
LOT L/ BLOCK I j
ADDITION ~/YJU/YL (J Jf A ;;~
1. DATE
11-~~ .0 \
RI
PI~~'" I~'" ooLj-D
4. OWNER (Name)
..xo +r c...o u...("
5. ARCHITECT (Name)
(Address)
(Tel. No.)
~ 5::;) .~~6' s:c:J.JJ
(Tel. No.)
L'\\
(Address)
6. BUILDER (Name) (Address) <r-J-r. ~ ~ _~ 8'(Tel. No.)
~'O\~. ~ ~ ~\J\ U.Q l"t-nc.....
baoo ~bb 6~\<<,~ ?~~ .S-\e.-;;t:::;o i ~~~.J\ 30~
7. TYPE OF WORK . Re-roofing a Porch a
New Construction 0 Re-sidin~ Finish Basement a
Chimney a Misc._
8. PROPERTY ARE
Sq.Ft.
CLOSE FILE
10/28/03 MP
10. CULVERT SIZE
Yes
No
File
~City
Applicant
11. SIZE OF S
(Height)
(Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PRO~~T~~Ll) 0
17. COMPLETION DATE
J8. JlJf\4 .6J
I hereby certify that J best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
the above mentioneo propeny ana mat all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
:uilding olficia n revoke this ~~hermore, I hereby agree tha~~croo~~gs!!:f!- enter upon the property to pew. needed insp~nsi
- Signature License No. ~
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ...................................:1'.
$
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
Permit Fee ..........~~~~i~~...1...~...~..~... $~ tJ.1,'
Plan Check Fee ............................. $
City:
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
I' ::1S"
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS a PERCOLATION TESTS a
PLANS & SPECS a SETS
SURVEY
PLOT PLAN
a COPIES
a
Pressure Reducer .......................... !t.
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $ ,
Total Due .............................. $ 'Iv rt7U
Paid /f fo ,() 0 Receipt No.
Issued . ;,Y' I-() ~
Date A";}.. -/ By ,
This is to certify that the request in the above application and accompanying documents is in accordance with the City ZoningOrdi~ance and may proceed requested. This document when
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
Sewer & Water Permtt ...................... $
Gas Fireplace Permit ....................... !l:
This Application Becomes Your Building Permit When Approved.
By Dare
Certificate of Occupancy
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850
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