HomeMy WebLinkAboutBuilding Permit 94-0268
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL TH AND SAFETY!
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CITY OF PRIOR LAKE
BUILDING PERMIT,
:ERTIFICATE OF ZONING COMPLIANCE
TILlTY CONNECTION PERMIT C) 2/ \7
Permit No. - ILl. ~ ,= (j
1. White
2. Pink
3. Yellow
File
City
Applicant
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
~3
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
PID ,J,S- ,L3b-1J l. f - D
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
14. FLOOR AREA APPORTIONMENT USE
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Fireplace 0 Septic 0
Alterations 0 Addition 0
~ I. .
Heating 0 Plumbing 0
Finish Attic 0 Residing 0
.~
Reroofing 0 Porch 0
Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. ESTIMATED VALUE
~ 300.00
17. COMPLETION DATE
6. BUILDER
(Name)
(Tel. No.)
10. CULVERT SIZE
;
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 thaI the
building ;:z.n revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X cd <..(1) ~L/ G:,'- f'- 9 51'
siQna ure Ucense No. Date
Yes
No
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
SETBACKS: Required
Actual
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
~..J.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
;;? ( 'Scd.((Th'
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
PERCOLATION TESTS 0
SETS
COPIES
Subtotal............................... $
56.\5
Check if
Deferred
Amount Brought Forward .................. $ !55" .
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 ........................... $
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A BEl H <<e M "t..
Division 1 ~3 4
City:
Plan Checking Fee ......................... $
s~.oc
I. 15'
Permit Fee ................................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
o
o
~r
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due ....:.>"'...................... $ 66'. ~
Paid IJ t;;' ~ /5 Receipt NO..;l. ~~~ 6/
~ ~~
Th. . ify he he . he bov I" nd . d . . d 'h h c~atze ~O"'-d~() -1d Y BYedd Th' . d
IS IS 10 cert I I t request In t a e app lcatlon a accompanYing ocurnents IS In accor ance wtt t e ity omng r Inance an may proce as requesle. IS ocument when
Si~B~..~:=tnlfl.e~rary Ce~~t~o~~LmPliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
City Planner Date Special Conditions ij any
ermit When Approved.
Date ~-~-CJq
24 Hour notice for all inspections 447-42309:00 a.m. '10:00 a.m.
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLlCAN~~~_'~
APPLICATION RECEIVED ' ~
The City of Prior Lake BUILDING Department has reviewed the
building permit applica~~9n for construction activity located at
Jj/J~ &(~ (j~jhS~ I~
Acc~Pted ~,r) Hzried ~ Accepted with Corrections
Revl.ewed bY:~ Date (4 -28-~
Comments:
~. 3~ ~~t~~~ ~~I~"o,-J~,,,l 1k...L..J t,~
o.i~~~<J~ '
2.. S,. :t-", ~ ,'~ ~~. - 5--.CA.. I~~
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"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."
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~/J'f.-""/:4 LIL/
APPLICATION RECEI'(ED tlf/lt}
The City of Prior Lake ENGINEERING Department has reviewed the
construction activity located at
permit"app~ica~n.for
CfLLU CtL~U, _lluul/
Accepted /' Df?aied
Reviewed by: \/ IiIM
/lir,t ~j
building
Lj /J ~
Accepted with Corrections
Date I~J-S(J/q~
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."
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~{/UI~~rJ.1L
APPLICATION RECEIVED t Ii /rl'l
The City of Prior Lake PLANNING Department has reviewed the
building.perm~t appliqpt~on for construction activity located at
L/)3 b lULl (j~ I!t~! ,-if'[ /LL,L
Accepted--t-
Reviewed by:
Denied
t/0tJ
Accepted
with correzo0
Date "8. 9'(
{ (
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."
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TEL NO.
Jun 30,94 8:12 P.01
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