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C p R `� P CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
B` ...
t. white File
2. Pink city ( PER NO. `/ ¢7'
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 5344 — 160 Street South East ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Mark Gemelke (Phone) 612- 849 -4236
(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 ❑Re- Roofing Eke- Siding ❑Lower Level Finish ❑ Fireplace
❑ Addition ® Alteration ❑ Utility Connection
CODE: ❑ I.R.C. ❑ I.B.C. ❑ Misc Replace 10 windows within exiting openings._
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST/VALUE $_13,296.00
r Division: 1 2 3 4 5 (excluding land)
1 hereby certify that I have furnished information on is pplication 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 a ■ that all construction ill onform 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 pe for ju ause. F� : e, . er/.y agr the e officirdesignee may enter upon the property to perform needed inspections.
X _ A, /1 20130983 6 /June /1l
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 7, 7J
This Application Becomes Your Building Permit When Approved Paid 7 ' • S ' Rec t No. 6 2 - 7 so
Date fir- /d' l/
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, Warty