Permits - Permit# 169 - 2478 Black Lake Road - 1/1/1973APPLICATION FOR BUILDING. PERMIT
VILLAGE OF SPRING PARK
.SPRING PARK, MINNESOTA
Please Print or Type
OWNER (Name)
(Address) ( I• No.)
PERMIT NUMBER,f
% 9
-v
ARCHITECT (Name)
(Address) ( Tel. No.)
ESTI MA C
�7(Ov
$
BUILDER (Name)
(Address) (Tel. NO.)
PERMIT ffEE
,�j`. L' a S
$ ti
DATE � / �:
PLUMBING FEE
LEGAL DESCRIPTION (Obtainable from Assessor's Office)
TOTAL
PLAT NUMBER
PARCEL NUMBER ZONING DISTRICT
$
COMPLETION DATE
r u
p
G
PROPOSED USE—
NUMBER OFOFF—STREET
PARKING SPACES
Residential
Nonresidential
Enclosed
One family
_ Two or more family _ Enter
— Amusement,: recreational
— Church, other religious.
Outdoors
number of units — ----
Industrial
Transienthotel, motel,
or dormitory — Enter number
—� Par king Garage
SPACES REQ.
of units-----------f--
— 'Service station, repair garage
�Gorage
Hospital, Institutional
SPACES ON PLAN
— Carport
Office, bank, professional
Other — Specify
�— Publ is Utility
School , library, other educational
NUMBER OF OCCUPANTS
OR SEATS
Stores, mercantile
^_ Tanks, towers
OCCUPANTS
Other — Specify
SEATS
TYPE OF WORK
LOADING BERTHS
NEW CONSTRUCTION ALTERATIONS
/
ADDITION �I NI SH ATTIC
FINISH. BASEMENT -PORCH
GARAGE REROOF-�ESIDE
NUMBER REQUIRED_
NUMBER PROVIDED
MISC.
SIZE OF EACH
SIZE OF STRUCTURE (Height) (Width, (Depth)
NO. OF STORIES
2- .
TYPE OF CONSTRUCTION
EXTERIOR FINISH
TYPE OF ROOF
PRINCIPAL TYPE OF HEATIICG
PRINCIPAL TYPE OF FRAME
Gas
TYPE OF MECHANICAL
Masonry (wall bearing)
_ Oil
Gr.
Will there be central air conditioning?
Wood frame
Electr l cit y
F. A.
Yes No
Structural steel
_� Coal
Wtr.
i
Reinforced concrete
_ Other — Specify
Stm.'
Will there be an'elevator?
Other — Specify
Yes No
& 0-3V6 a (COMPLETE REVERSE)
t1q o
PROPERTY LINE
DIMENSIONS
Total square feet of floor area,
all f loors, based on exterior
di mensi ons ..... .
Total land area, sq. ft.
SPOT BUILDING/s SHOWING SET BACKS
STREET
PROPERTY LI NE
SCALE: 1/8" 1 FT.
The undersigned hereby represents upon all of the penalties
of law, for the purpose of inducing the Village of Spring Park
to take the action requested, that all statements herein are
true and that all work herein mentioned will be done in accor-
dance with the ordinances of the Village, Statutes of the State
of Minnesota, and rulings of the Buil g nspecto s.
APPROVED
VILLAGE OF SPRING PARK APPLICANT
DATE: DATE: