HomeMy WebLinkAboutBuilding Permit 07-0433
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l:lATF RE-~EIVEO
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
\~(,\)
I. Whilc
t.. Pink
~ Yellow
HI<
C;\y
^pplicalll
Permit No.
07 04-33
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE fIllED IN
BEFORE PERMIT 1$ ISSUED (Please P';'ll o. TyCQ and sigM :11 Oollorn)
2. SITE AOO~ESS
/0 38 FC)~$ 0 ~ ~f) 5, ~
3. lEGAl. DESCRIPTION
1. OATli
//-1"7-0&
BUilDING INFORMATION
11. SIZE OF STRUCTURE
lH"9>') lWldlhl (Oeplhj
12. NO. OF STORieS
(A"<'ress)
lOT
AOOITION
4. OWNER (Name)
I 1- ~ INDY
S. ARCHITECT (Name)
BLOCK
PIO_.
(AOoress)
(Tel. NO.)
~fUrl(.c\.n pj~{b'\:~'l~ltv'3 Jnc. \)..Jl{l1\J.cd~i
SeptiC (J
Allcllnon 0
7. TYPE OF WORK
New ConsUUCllon 0
Fireplace n
Allerallons 0
OeClC r:t
Finlsn Allie C'I
1S. NUMBER OF OCCUPANTS OR SEATS
OCCU~"NTS
6. BUILOER
(Name)
(AlldrOl'S l
ChimflllY a Misc.
a. PROPERTY AREA OR ACRES
So. Fl.
9. PROPERTY DIMENSIONS
w.<'\lI Dep\h
10. CULVERT SIZE
Yes No
SEATS
16. PROJECT COSTNAlUE
12/000.00
17. COMPLETION DATE
I hereby certify \hat l!\ave l\lmlsh9d Inlormatlon on 1his epplicatlon whlcn Is to me best or my knOwledge rrue ar>d correa. lal:;o certify lhall am tf">e owner Of l\Ul~riZ.ed aoen11or
l~ ;leave men\ioned property and \hal aU conslruCllOn will conlorm 10 all exlsllng stlJle and loc8llaws and will proceGO in s=rdance wtth subm;Ueod plans. I am 8V;8r~ lhat !he
bulldi 0" I c~ re.')>ke Ihl t Jor just cause. Furthermore. I hareby agree Ihal tha city olllclal or 8 designee may enter UDOl\lhe property 10 perfn"" ""...-1_" 'n'n_l;n"'.
X^-. 2o/c::>93g3
l-,...,.. No.
Dole
FOA ADMINISTRATIVE USE
Front
BUILDING DEPARTMENT VAI.UATfON
Ila'"
5108
MATERIAL ALEC WITH APf'UCATION
$Ode SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TeSTS 0
PlANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN n
SETBACKS: Requlred
Aclual
USE OF BUILDING
OFF STl'IeET PARKING
SPACES ,"EO.
SPACES ON PLAN
PERMIT VALUATION
T'fPE OF COI'ISTAUcnolt: 1 n III IV V
OcoupancyCroUP A e E F HIM R S U
~ I 23.
Pertlllt Fee ................................... $
C11y.
Amounl Brought FolW;lrd . no ... . ....... ... S
Parle Su~o" Fee .....................,..... $
SAC ......................................... S
Collective 51roel Fee ....................... $_.
SewerTBP ................................... $
s
Pressure Aeduc:er .......................... $
Meter Ham ............................... .... S
Wat.,Ue,er ................................. S
Sewer & Waler COnllection Fee ........... S
Willer To....r Fee ..................... ...... S
W;ltorTap ................................... S
BUild...... Deposit ...................... ...... S
Ollie' ......................................... S
Total Due .......................... ..
Paid ./ A/J
Plan CheCll: Fee ............ .... ..... ........ S
SUlls Surcl1I1'!la ............................. S
Pena1ly ....................................... S
Plumbing Perm~ Fee ....... ................ S
Mechanical Permll Foe ..................... S
$ewer 6. Water PSll1'lll ..........:........... S
GaS FIreplace pennlt ....................... $
This AOPkaUon BKOmR YOIX BuDdlng Pe....lI When Approved.
- ~~
Cer1lfIeal6 of Occupancy
IssueO
Dille . IJ
thIS IS 10 cerdIy lhallhe I'llquest In \he above ~lIllII and ec:eompanylng ~menls Is In ~nce wllh !he City Zonng Of(l\nerce and may ~
sign81:1 D'I' \h8 CIty Plenner constl\l.JleS Ill8mpOnlfy Cer1lrO\8 01 Zoniftg co.....aftCe and slows eons\lucllon 10 eo.nrr'8I\al. Balore OCCl()8ACy. a
Clly~
0118
Sc>K1oI CondltJO'lI l e"1
.,. ""'or ......... ,... .llnI:nN:IlOnS 447-911:50
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