HomeMy WebLinkAboutBldg Permit 01-0868
DATE RECEIVED 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)
2. SITE ADDRESS
1 Lt '=Dq to U. )(' 1 +er-s ed0J2.. '\ 't" \ l
3. LEGAL DESCRIPTION Lf-1 . -1
LOT ;3- 1 BLOCK P-0Ztff~ PID;;S- - 11'1.... IJ!i-o
-- g){tA1 tY1/
(Address) (Tel. No.)
14oC\to (~~~~ '1((\\' (T~~)-Ll41-U\4
1. DATE
<6- \4 -0\
N.S
ADDITION
4. OWNt{e\ \-\\ Llit~ US
5. ARCHITECT
(Name)
6R~~~ ~emr~w.. QSO<6 L~~&.~ ~es ~;;~8'~44CJ
7.TY~~CLtt~rePlaceo ~\~\\l~~ S~~~~n~ Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic a Re-siding a Finish Basement a
Chimney a Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft. ~'::>
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
na'Sl
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit NoOI- 0 8,1
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
'13litp. q I
17. COMPLETION OAT';
8-aD-O\
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 me ioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
:uilding offici oke this .~se. Furthermore. I hereby agree that the city off~i4Jlil(j enter upon the property to pertog:ilJ ~tirS'
Signature License No. Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................................... or
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
FOR ADMINISTRATIVE USE
SETBACKS: Required
Side
Side
BUILDING DEI
USE OF BUILC
CLOSE FILE
10/28/03 MP
. PARKING
t
PLAN
JATION
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4~ J./ s'"
Permit Fee ................................... $~ 7,,,. 7
City:
Plan Check Fee ............................. ,.
State Su rcharge ............................. $
J, ~S--
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... ,.
This Application Becomes Your Building Permit When Approved.
By Date
MATERIAL FILED WITH APPLICATION
SOIL TESTS a ENERGY DATA a
PILING LOGS a
PLANS & SPECS a
PERCOLATION TESTS 0
SETS
COPIES
SURVEY 0
PLOT PLAN
a
'/~~
Total Due .............................. or
Certificate of Occupancy 1lh
Paid, ...('0 Receipt No.
Issued . . . . ,
Date ~"'-ls.-ol By ~/
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 uested. This document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate cupancy must be issued.
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850