HomeMy WebLinkAboutBuilding Permit 94-0304
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL TH AND SAFETY!
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CITY OF PRIOR LAKE
BUILDING PERMIT,
RARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT . ~ -"3 ^J I
Permit No.' - u-,
1. While
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)
. SITE DO ES~
LOT
ADDITION
4. OWNER
6. BUILDER
(Address)
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Heating 0 Plumbing 0
Finish Attic 0 Residing 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 9. PRO":ERTY DI~NSIO~S 10. CULVERT SIZE
Sq. Ft. idth .ODePth 'J Yes No
I hereby certify that I have furnish nformation 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 official rev this permit fo t c . Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed insp~ons.
X UcenseNo. 7 -!- 'I
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
PLOT PLAN
o
1"71.BS-
Check if
Deferred
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 ........... $
WaterTowerFee ........................... $
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A BEl H(B>M
Division 1 :04
City:
Permit Fee ................................... $
43.eo
'2~.9S
. 'W-
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
o
o
Issued
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
j
Paid
This is t certify that the request in the
yt W~sttt s
City Planner
Special Conditions ~ any
24 Hour notice for all inspections 447-4230 9:00 a.m. . 10:00 a.m.
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BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT d..J;-.~~, 1.1yu~/
APPLICATION RECEIVED 7/ f h Sf
The City of Prior Lake BUILDING Department has reviewed the
building permit application for construction activity located at
/ if J '10 dhl'l.l/ ,XlL,-.Lj
Accepted ~enied
Reviewed bY~ .
Comments:
Accepted with Corrections ~
Date j-I L{-1Lf
"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."