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CITY OF PRIOR LAKE BUILDING PERMIT, PORARV CERTIFICATE OF ZONING COMPLIANCE TILlTY CONNECTION PERMIT 1. DATE 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 3. LEGAL DESCRIPTION & LOT ADDITION . (Tel. No.) fN,., low W 01:/ C'i e ((. 9'fL' '1'10- 1-Tfl>' (Tel. No.) 5. ARCHITEC (Address) /6 (; (Address) .;~" (Name) Fr~~-I-{elL C6kS ~. (Address) (Tel. No.) I S'06 6 f3,.,J:Je"'.~' (};Vt,rAVA,e.,/tf,.. Septic 0 Addition 0 9')2.-vYo~1":1$O Fireplace 0 Alterations 0 Deck Finish Atti 0 Re-roofing 0 Porch 0 Re-siding 0 Finish Basement 0 7. TYPE OF WORK New Construction 0 Chimney 0 Misc. 8. PROPERTY AREA OR ACRES Sq.Ft. 10. CULVERT SIZE 9. PROPERTY DIMENSIONS Width Depth Yes No 1. White 2. Pink 3. Yellow File City .:i, App~ j'.',f:" 12. NO. OF STORIES 13. TYPE OF CONSTRUCTION 14. FLOOR AREA APPORTIONMENT USE 15. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS SEATS 16. PROJECT COSTNALUE 17. COMPLETION DATE I hereby certify that I have fumished 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 and that all ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building 0 .. an r . pe 1 for just ca rmore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X dCJ o6o~/o 7-<f/-ZOoQ License No. DIIe FOR ADMINISTRATIVE USE SETBACKS: Required Actual Back Side Side Front BUILDING DEPARTMENT VALUATION OFF STREET PARKING SPACES REO. SPACES ON PLAN PERMIT VALUATION 3,000. c:> c USE OF BUILDING fu ~ TYPE OF CONSTRUCTION: I II III IV V Occupancy Group A B E F HIM R S U Division 1 2 3 4 MATERIAL FILED WITH APPLICATION SOIL TESTS o ENERGY DATA o PILING LOGS 0 PERCOLATION TESTS 0 PLANS & SPECS 0 SURVEY 0 PLOT PLAN 0 SETS COPIES Permit Fee ................................... $ 1"'.1S- t.{ '8 . s-1 1.50 Amount Brought Forward .................. $ Park Support Fee ........................... $ SAC ......................................... $ Collective Street Fee ....................... $ Sewer Tap ................................... $ $ City: Plan Check Fee ............................. $ State Surcharge ............................. $ Penalty ....................................... $ t\oo Pressure Reducer .......................... $ Meter Horn ................................... $ Water Meter ................................. $ Sewer & Water Connection Fee ........... $ Water Tower Fee ........................... $ Plumbing Permit Fee ....................... $ Mechanical Permit Fee ..................... $ Sewer & Water Permit ...................... $ .. Permit WheZApproved. 0 Date e- -2a? Issued Thisist signed y Date fy that the request in the above application and accompanying documents is in accordance with the City Zoning rdinanc and may proceed s r uested. This document when City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate 24 hour notice for all inspections (952) 447-9850 Special Conditions ff any City Planner Date .. .~ . - .:~~_. . . . ---.....-.-.. -'~ ..-. - . .. . --..-.-. ..". .-. ....'.; : ,... . ..... ,~._ ._. .._. ~"d'.._ ... Residential Building Permit Checklist Deck Additions to Single Family Homes B~ Date:8 '2-~ Building Permit # 00" 01 ~ PID: Site Address / t,eJt;s, UJc'{~~ Zoning: B Subdivision: Legal: L Existing Structure: YES or NO CONFORl\1S TO ZONING ORDINA1~CE NO I Yard Setbacks: NOT APPLICABLE Requirement Proposed :MEETS CODE . Side Yard 10' (25' if abutting a street, 30' if abutting a street ~'7 ~ in Cardinal Ridge) . Side Yard 10' , set . Rear Yard 25' 75' ANY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUST BE REFERRED TO THE PLANNING DEPARTMENT. ALSO, ANY DECK ON A LOT WITH A SUSPECTED BLUFF, OR Al'IY OTHER UNUSUAL CIRCUMSTAl'fCE MUST BE REFERRED TO THE PLANNING DEPARTMENT. THIS CHEClUIST MUST BE COMPLETED MiD INCLUDED IN THE BUILDING PER.l"IIT FILE TO MAINTAIN A RECORD OF THE REVIEW. L:\TE.iYfPLA TE\DECKCHCK.DOC White - Building Canary - Engineering Pink - Planning The Center of the Lake Country BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED F f'C\\\"\- \ ~ C 0 ~truct1 r 1Y'l u\j\~ 0\'\ aoot) The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: \ CO ~Co <6 L.U \ \ \ aU.. ) \.JJ ffi"\cl C 1 rcl a .J Accepted ~ Accepted With Corrections Denied QA-"o Reviewed By: (j;:"~_ -=-- Date: B -'2--- ~ ~nts: lft~.-f/4 ~ ~~.. "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." I I- I P.RIOR LAKE INSPECTION RECORD SITE ADDRESS 1~80J6 LJ:\lC)~~ TYPE OF WORK ~~ (q'X'CJ)' USE OF BUILDING ~FD PERMIT NS:- 00 -""~ BUILDER r~t\l~ _ NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT DEPARTMENT OF BUILDING AND INSPE~TI.aN DATE ISSUED <9 -""2.-~ FOOTING PLACE NO CONCRETE UNTIL ABOV I FINAL Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS 447-9850