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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
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 5,a /'A j1 ~
'- f L-/fN!)'( lOIlG" f RAI L
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
/"
BP6~-/ftl'J
1.D~ \ 7
ZONING
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
d--
BL~ I
(;2 )V/S / dL-
.-J.5~ /Iq;)- OJ'
PID'/'< U d
/420110-'0 j \/
_1~. OF STORIES
13. TYP~F CO TRUCTION
t::..e b
14. FLOOR AREA APPORTIONMENT USE
LOT
ADDITION
4. OWNE
CE~o
(Name)
, (Addre",)
~
(Address)
~
5. ARCHITECT
(21-7 CwP ~
Septic 0 Deck 0
Addition 0 Finish Attic 0
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
10. CULVERT SIZE
Yes No
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTN~UE
',Sqv
17. COMPLETION DATE
lo ( '"b"
License No.
Date
FOR ADMINISTRATIVE USE
Front
8ack
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Subtotal............................... $
is Application Becomes Your Building Permit When Approved.
.jY Date
ificate of Occupancy
,..sued
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collector Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
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 as ested. 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
24 hour notice for all inspections 447-4230
Special Conditions d any