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"z" 0 (I) 0 < m Z 0 0 > II> > lD 0 3: :z: , ::3 (") m Z " m , n 0 m 0 'TI , 9 !D m :z:0 m c (I) oJ) -t , Z ~ cm 0 00000000 m m 0 0 :DO " 'TI(/)"IIo>m~ (/)0 < :z: -moo X-i -m 0 ~"'3:"'om ~ z:D -t "lJ::!5"rn>z 0 (/)- 0 >o:E>:Z:;::(/) , 0 "Z -t 0 > mG) > 0'TI.-0G)" Z ~ -t 0 mZCz:II:Dm - -t '" >,,-tm>o -t ..I:. m ~ 0 m ... ~o::! ::z:J :D Z ii mZO b' ~ -tOz "0 ~ , >1l V' ~ ~ , z, ~ . . ~ '" :D oC -t I m (/)z ~ f ~ -t 0 Q N c m vi eN :D ~ Z ~ 0 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE (---x? " /' C 1. AND UTILITY CONNECTION PERMIT Permit NoD~';1- ( 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 <.-7C<- (-((ie" ,-,~cn.j c;,r, N. c-.' 3. LEGAL DESCRIPTION SECTION ADDITION 4a 1/ ( 4. OWNER <:C:l / t 5. ARCHITECT d j BLOCK PARCEL NUMBER 2.:" 23QCO&c) 13. TYPE OF CONSTRUCTION (Name) c--;: "'~ l,i.// (Name) (Address) -",<, . ~ , (Address) 1. White - City 2. Yellow - Assessor 3. Pink - Applicant 1. DATE BUILDING INFORMATION 11. SIZE OF STRUCTURE (Height) (Width) (Depth) 12. NO. OF STORIES I (Tel. No.) 14. FLOOR AREA APPORTIONMENT USE (Tel. No.) \Address) (Tel. No.) (- /.C I: 'oK / ;".>C c;C 7. FireplaceO SepticO Heating 0 PlumbingO Reroofing 0 New Constructioni;a Alterations 0 Addition 0 Finish Attic 0 Residing 0 Finish BasementO Porch 0 GarageO ChimneyO Misc. 8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE Sq. Ft. . 0 Width Depth Yes No 15. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS SEATS 16. ESTIMATED VALUE c; "": 'C(~] 17. COMPLETION DATE 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 ali construction wili conform to all existing state and local laws and wlil proceed In accordance with submitted plans. I am aware that the building off~al can. revoke thispermit for just cause. Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspec- tions.<~ '?~ / / . / ,,' 'I' ~ '. -7 C" "c/' X ",''''c>l, If{,{."':'iV;';tv' j(/'- < c:" ,.,~; Signature Date SETBACKS: Required Actual FOR ADMINISTRATIVE USE Front Back Side PROPOSED GRADE FOUNDATION IN RELATION TO CURB OR CROWN OF STREET ~ ~ USEOF BUILDIN ~L 4..(\..1 ( OFF STREET PARKING PLANS & SPECS ft- SPACES REO. SPACES ON PLAN;- SURVEY..p PERMIT VALUATION GL;)o4 .3..lf~ PLOT PLAN 0 Amount Brought Forward. . . . . . . . . . . .. $.2:: ;:l Park Oed. . . . . . . . . . . . . . . . . . . . . . . . . . . ,. $.J 0~ D ~ Sac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ s.s;c::-,. c.::. ~ Plumbing............................ $ Sewer Tap........................... $__ Sewer Hook-up.. .. .. .. .. .. .. .. .. .. ... $ ;)u ':;:0 Water Hook-up....................... $ -S.".Sb Meter Horn. . . . . . . . . . . . . . . . . . . . . . . . . .. $ ___ Water Meter. . . . . . . . . . . . . . . . . . . . . . . . . . $ l< (~ ' C:::i:::~ Check if [irSe~ & Water Connection Fee. . . . . .. $-~ ~ "' ~, Deferred lzrW'ater Tower Fee................ ... .. $ ."t.,.,,-;~ 8:', Water Tap ............................ $ City Fee.............................. $___ Other.. .. , .. .. . .. .. .. . .. .. .. .. .. . .... $ {;;. C t.. d Total Due. . . . . . . . . . . . . . . . . . . . . . Paid Receipt no. 1::5 / :3 '3 Date IC}.7i / ~S; By ( /' t e request in the above application and accom anylng documents is in accordance with the City zO~ing OrJlnance and may proceed as questea. This docu, he City Planner constltues a tem~'k~;rtlfl ~f zonln~comPllance and ~1I0WS construction to commence. Before occupancy, aCe tiflcate of o:c~~~y Date Special Conditions if any TYPE OF CONSTRUCTION; IIIIIIIV Occupancy Group A BEl H(8)M Permit Fee.......... .D.i~I~I.o.n.1. ~..... ~ ?if. $:Q, . .2~CZ '7--- Plan Checking Fee. . . . . . . . , . . . . . . . . . .. $ .-:::-- State Surcharge.. .. .. .. .. .. .. . .. .. ... $ .::s L. D 2- Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ Septic System. . . . . . . . . . . . . . . . . . . . . . .. $ Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ Subtotal....................... $1.4Y. '::L 1 , City: This App i ation Becomes Your Building Permit When Approve Date (~- Z- rz - ~'~" // By Certificate of Occupancy Issued 24 Hour notice for all Inspections 447-4230 9:00 a.m. ' 10:00 a.m, Side MATERIAL FILED WITH APPLICATION SOIL TESTS 0 ENERGY DATA fr. PILING LOGS 0 PERCOLATION TEST SETS COPIES J- [J