HomeMy WebLinkAboutBuilding Permit 94-0568
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OiTY OF PRIOR LAKE
I '~UILDING PERMIT,
IFICATE OF ZONING COMPLIANCE
ITY CONNECTION PERMIT
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 /I
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3. LEGAL DESCRIPTION
Permit No.
1. DATE
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1. While
2. Pink
3. Yellow
File
City
Applicant
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
LOT
PIO 0{5-0'''- O()I-D
12. NO. OF STORIES
'/Lv' 0
ADDITION
I)-bh()
13. TYPE OF CONSTRUCTION
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14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT Il (Name)
6. B).JlJ-DER. (Name)
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7. TYPE OF WOR
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
I)... b I:J () /1-
(Address)
(Tel. No.)
J./L/o "" .....--? {, (, '-
Heating 0 PI~inWZ', ~9.1'~ Porch 0
-)=in ish Atticp ~,Pfes~~ i/ ~~1'h Basement 0 .
,f:ff/ A., I / tlV~ {..-{' )./ ,// /(J (1 J..; &.' IIf .-
ERTY DIMENSIONS 10. CULVERT SIZE
Depth Yes No
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. ~ESTIMATe.E VALU:. "c:a:::J
HI, (I,J .L....._ J
17. COMPLETION DATE
/J=- 3 6 - 7t.r-
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 a. nd that all constructio.n will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aw~are that the
build' cial can rE1voke this perm' r us cause. u ermore, I hereby agree that the city official or a designee may enter upon the property to perform ne~ i.98p . ns.
X j0.::"h / ~ ; - / / .2/IY , Y
Signature Ucense No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
"
TYPE OF CONSTRUCTION: I " III IV(Y)
Occupancy Group A BEl H ~
Division 1 ~
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
City:
Permit Fee ................................... $
g D _ c.)~
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System............................... $
Other ......................................... $
::3:::. I ~ ~
q~. ~~
Check if
Deferred
.............................. $
By
mas Your Building Permit When Approved. }
. Date I 2.,. 2.., - c::; 4
Certificate of Occupancy
Issued
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid '. d 0
Date ,'u.l/ I
PERCOLATION TESTS 0
SETS
COPIES N IA
Cfs". o~
This is to certify that the request in the above application and accompanying documents is in accordance wtth the City Zoning Ordinance and may proceed a
si ne~the City P r constttutes a temporary Certificate of Zo~g}Ompliance and allows construction to commence. Before occupancy, a Certificate
! ,I. - I~-~_'~
City Planner Date Special Conditions ~ any
24 Hour notice for all inspections 447-4230 9:00 a.m. . 10:00 a.m.
eo ~
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White - Building
Canary - Engineering
Pink - Planning
The Cenler or the Lake Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ttl~1h;: llff
APPLICATION RECEIVED _~Sj__
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4ft,] J.",fj,.JF j;/k"LJ t.
Accepted
I-
Accepted With Corrections
Denied
-~
Date: I"L- 2..\-9~
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."