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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
Es. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Q 1.7.1 AND UTILITY CONNECTION PERMIT
NAT Es°
t. White File ( PERMIT NO. // / }r I
2. Pink City PERMIT NO. // , / L
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 15173 Ellen Circle SE ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
•
OWNER
(Name) Tammie Colton (Phone) 952- 447 -5809
(Address) (Site) -
BUILDER
(Company Name) Renewal By Andersen (Phone) 651- 264 -4777
(Contact Name) (Phone)
(Address) 1920 County Road "C" West, Roseville, MN 55113
TYPE OF WORK ❑ New Construction ❑ Deck ❑ Porch DRe-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑ Addition ® Alteration ❑ Utility Connection
CODE: ❑ I.R.C. ❑ I.B.C. ❑ Misc Replace 4 Windows, 2 Patio Doors within exiting openings.
Type of Construction: I 11 III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $_11,629.00
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have f ished 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 , d that all constructio conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this t i • .r ju use. Furt e, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x _ ...24A411 �� 20130983 30 /June /1
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ - 7 9' 7 ,-
This Application Becomes Your Building Permit When Approved Paid Receip o. l0. 4
Date '7, 11 _ By .
Building Official 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 requested. 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.
Planning Director Date Special Conditions, if any ^