HomeMy WebLinkAboutBldg Permit 02-0136
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
PAJDt t.11. 0 8 zacz
q5~. 4t;;~.)'I'/1,).
'Iot.e.lq~6'~9
::~g::~~N~.,__~S8~~_~' ~fl~~~
New Constructlol Re.sldlng..Gt Finish Basement ~
Chimney ~ Mis
8. PROPERTY p CLOSE FILE 10. CULVERT SIZE
Sq. Ft. 10/28/03 MP Yes No
I hereby certify , the best of my knowledge true and correct. I also certify that I am the owner or authorized agent lor
the above mentkn~... .., -.- -ffi __h____ .sting state and local laws and will proceed In accordance with submitted plans. I am aware that the
building officlal can thl& perm r Just ca.wAui\1e,gnore, I hereby agree that the city official or a des_~nee may enter upon the property to perform n~ons.
XL' flt:I:lJO d /7 -:; # ;:).
S91at~ - . - License No. . I
~
2-/1- 62-
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
'~)(p/{):J,
5 061 d.-
2.SITEtll41B PO;u PoiA~ &M1e 1 PM~ /.JAb
3. LEGAL DESCRIPTION
/
LOT
BLOCK
PID
ADDITION
4. OWNER (Namel . 2'
!YJtc..ir ~ eAr',st, M i ~
5. ARCHITECT (Name)
(Address) . 1 ,~
,- ~ l.--1D
(Address)
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
PERMIT VALUATION
4Jz/ SeJ O. 00
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
1. White
2. Pink
3. Yellow
File
City
Applicant
B,,!. .. G INFORMAnON
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
17. COt.h"LC . ION DATE
MATERIAL FILED WITH APPUCAnON
SOIL TESTS ~ ENERGY DATA c:J
PILING LOGS ~ PERCOLATION TESTS ~
PLANS & SPECS ~ SETS
SURVEY
PLOT PLAN
~ COPIES
~
City:
Amount Brought Forward .... .... .... ...... $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Hom........... ......... .... ........... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7 ~. 00
Paid ~ &. 0 0 ReceIP'!J~-, 4/2-/ 4-
Date 2:"'/1- 02- By 44fL.,
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 Is "requestad. This document _
signed by the City Planner constitutes a" ..,. .<IV Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certiflcata of Occupancy must be Issued.
Occupancy Group A B E F H IRS U
Division 1 2 3 4
Permit Fee ................................... $
'7LJ.76-
Plan Checking Fee ......... on............. $
State Surcharge............................. $
/, -vs:-
Penalty ....................................... $
Septic System ............................... $
Other......................................... $
Subtotal ............................... $
This Appllcatl?.?'1mJlYour B~lIdlng Permit When Approved.
By /U/v:J Date ~...H-oZ-
Certificate of Occupancy
Issued
City Planner
Special Cond~ions n any
Date
24 hour notice for all i...... ,"~;;ons 447-4230