HomeMy WebLinkAboutBldg Permit 01-1087
QATE RECEIVED CITY OF PRIOR LAKE 1.
BUILDING PERMIT, /j 2. L
TEMPORARY CERTIFICATE OF OI--/eJr ( 3 Ye\>, .'
ZONING COMPLIANCE - , /
AND UTILITY CONNECTION PERMIT Permit NO...Qy / () y. ,
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
q1:R/D I
BUILD INFORMATION
11. SIZE OF RUCTURE
(Height) (Width) (Depth)
2. SITEt,D~~S~ '/1 IJ
~'1 fhGL1\; taLt" f.-A'
3. LEGAL DESCRIPTION
LOT ~ . BLOCK
ADDITION Koppe, ~f (j.Mi
4. OWNER :fd ~ Name) (Address) I
c:::ct.J > I 4 q 11 q (Y\ll'-1\ I +Olo1
5. ARCHITECT (Name)
12. NO. OF STORIES
PIDd5- $3" ct5t:,-O
13. TYPE OF CONSTRUCTION
(Address)
(Tel. No.)
rtA. 4'11-11s''1
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address) t?J 4 t.{ D /'" JI)MfL (Tel. No.)
8~ J -1<[ Jq
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
t\^{) G '1-, ~p 10.] c.. U.
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofing 0 Porch 0
New Construction 0 Alterations 0 Addition 0 Fini,ij1 Attic 0 tRe,siding 0 Finish Basement 0
Chimney 0 Misc. I-e- ~ - IJ1 ) /:1 ~ (Luo ~ ~
8. PROPERTY AREA OR ACRES 9. PRO~RTY DIMENSIONS '-' 10. CULVERT SIZE
Sq. Ft. Width Depth
Yes
No
SEATS
16.~OJECT COSTNALUE
.J I. ODO
17. COMPLETION DATE
/ () --I j-() J
I hereby certify that I have furnished information 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 and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building offewrevoke this permit for just cause. Furthermore, I hereby agree that~icial or a designee may enter upon the property to performteed:.d rspections.
X ~ -/ItA.1~ y; '1 d;; ~ I 3/;;- aLl'J 'J
. . I Signature License No. Date
FOR ADMINISTRATIVE USE
BUILDING DEPAR'
CLOSE FILE
10/28/03 MP
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SETBACKS: Requ'
Ac
'lKING
USE OF BUILDING
.N
l PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Permit Fee ..........~~~~~.~..:...~...~..~... $ 7l/r '7'5'
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
/.~
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Gas Fireplace Permit ....................... :l' Water Tap ................................... $
This Application Becomes Your Building Permit When Approved. Builder's Deposit ............................ $
::.."" of 0="",, 0.10 :::';~~~;;:::::::::::::~:~;;~:~~' ~
Issued .
Date I ().- ~ -0 I By Qr-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 proceed a!Jequested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
CRY Planner
Date
Special Conditions n any
24 hour notice for all inspections 447-9850