HomeMy WebLinkAboutBuilding Permit 94-0152
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH AND SAFETY!
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AN
R1'~ITY OF PRIOR LAKE
I BUILDING PERMIT,
RTIFICATE OF ZONING COMPLIANCE
ILlTY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 2- - 15 '"'2..-
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
G-q-Ci
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
(!)r~lD
12. NO. OF STORIES A, -r--
...>7""'-1 I I
13. TYPE OF ~STRUCTION
14. FLOOR AREA APPORTIONMENT USE
LOT
ADDITION :I. S
~ER ~~ 3'-1~~ e;\lSS)
... rl
5. ARCHITECT (Name) (Address)
PID
'75- \'1):- OUo-O
(Tel. No.)
6. BUI DER Ltn (N~III~ Wttddret
7. TYPE OF WORK Fireplace 0 Septic 0 Heating 0 Plumbing 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Residing 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
(Tel. NOllL/D_1 ({f)
Reroofing 0 Porch 0
Finish Basemen~
15. NUMBER OF OCCUP
OCCUPANTS
SEATS
16. ESTIMAT. VALUE
S~C().IO
1 . COMPLETION DATE
S OR SEATS
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
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
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X ~ S""-;D-- 9~
S nature Ucense No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
fJ _ J
+:""~~ ~
TYPE OF CONSTRUCTION: I II III IV f!!)
Occupancy Group A BEl H 6> M
Division 1 ~
Permit Fee ................................... $
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS ~ SETS
SURVEY
o COPIES
5600
PLOT PLAN 0
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ... ..................... ..... ............ $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o Water Tower Fee ........................... $
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
8.\.co
S"2 ,bS
~ . ")-0
Subtotal............................... $
I-S(o' ~ lr
Check if
Deferred
By
Certificate of Occupancy
Issued
Special Conditions ij any
24 Hour notice for all inspections 447-42309:00 a.m. '10:00 a.m.
q1/ - /j2
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~ '~J/
APPLICATION RECEIVED~/I_
The City of Prior Lake BUILDING Department has reviewed the
bUilding.;fe e"rmrm~ilt application for construction activity located at
,-1 1J3 ~J d.JxuE' J zJ,
Accepted with correctionsY--
Date
Accepted ~d
Reviewed by: ~ ~
Comments:
"The issuance or granting of a permit or approval of plans,
specifications and computations shall not be construed to be a
permit for, or an approval of, any violation of any of the
provisions of this code or of any other ordinance of the
jurisdiction. Permits presuming to give authority to violate or
cancel the provisions of this code or other ordinances of the
jurisdiction shall not be valid."