HomeMy WebLinkAboutBuilding Permit 00-0867
Chimney i:J Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have furnished ",;"'......;:"'., on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for
the above mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitled plans. I am aware that the
building cial can r vak his pe it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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License No. o.te
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QAT. ..r..1JlEQ CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
q-d5-~
12. SITE ADDRESS
S~()ln
(jaiL ~Yu S IA)
3. LEGAL DESCRIPTION
LOT I 0 BLOCK
[}111I
IC-R ~~
5. ARCHITECT (Name)
PID (J5-1I1-/?/D .-0
ADDITION
I .
tJ.rf 1fJ.~
(Address)
536' ()o1.u.-
(Tel. No.)
~'/<J-:I1~tJ
(Tel. No.)
(Address)
6. BUILDER
(Name)
(Address)
~14v
(Tel. No.)
;/'l,1-c, ftj/
-P~ /2~
7. TYPE OF WORK ' Fir~place D
New Construction D Alterations D
Septic D
Addition D
DeckD
Finish Attic D
Re-roofin~ Porch D
Re-siding D Finish Basement D
x
Signature
File
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Back
Side
Side
Front
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
Pennit Fee ................................... $
City:
Plan Check Fee ......................... .... $
State Surcharge ............................. <t
Penalty ....................................... $
Plumbing Pennit Fee ....................... ~
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS D ENERGY DATA D
PILING LOGS 0
SURVEY
Gas Fireplace Pennit ....................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
This Application Becomes Your Building Permit When Approved.
By Date
Total Due.....1/O.................. $
Certificate of Occupancy Paid '-114'" ReceiBlNo....:s~1{5~
Issued -
Dateq-;;S-Ou ByU r (!A~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceek ~uested. 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.
24 hour notice for all inspections (952) 447.9850
Special Conditions ~ any
City Planner
Date