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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
`�' AND UTILITY CONNECTION PERMIT
4,r A E
1. White City I PERMIT NO . 1
2. ell App licant /� 5
3. Yellow Applicant !!
(Please type or print and sign at bottom)
A DDRESS 15341 Fairlawn Shores Trail SE ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Bernice Ohmann (Phone) 952- 447 -7192
(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 DRe-Siding ❑Lower Level Finish ❑ Fireplace
❑ Addition ® Alteration ❑ Utility Connection
CODE: ❑ I.R.C. ❑ I.B.C. ❑ Misc Replace 7 Door within exiting openings._
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COSTNALUE $_9,844.00
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I ha e furnished 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 pro. e and that all const on will 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 thi ermit r just cause. Fu ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x All # 4 j a • 20130983 Is!sFPT't 1
V Signature Contractor's License No. Dale
Permit Valuation Park Support Fee # $
Permit Fee $ SAC N $
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 $
This Application Becomes Your Building Permit When Approved 1 Paid '1 9. 73 Receipt No. C!) ¢/ 4 t
Date %. 2./, 1/ By
Building Official Date L
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