HomeMy WebLinkAboutBuilding 06-0369
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DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.06- 3 ~ q
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
~
'12-
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
/i.IJ()I7 Veur; r;u,1!:' el-f)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
-rHp ..
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
G14-3DS3
SEATS
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Re-roofing
Re-siding 0
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
x
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
USE OF BUILDING
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee................................... $
V
R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC .........................................$
Collective Street Fee ....................... $
Sewer Tap ................................... $
Plan Check Fee ............................. $
d .s- c;(9. ,-
-;! L( 75
I'd Z)
State Surcharge ............................. $
$
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn................................... $
WaterMeter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid ------
//~.
----
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed s q sled. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
City Planner
Date
Special Conditions n any
24 hour notice for all inspections 447-9850