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05/10/2009 20:09 5072483151 K CUSTOM HOMES INC PAGE 02
'i PR1 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd�
,, ,; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE S / Z
. • AND UTILITY CONNECTION PERMIT
4"/NNe I. White fife Pink City PERMIT NO0 077
4
3 Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ 5 9g 4 plien34 OE P 0t-i. AjCe., PA:1
LEGAL DESCRIPTION (office use only) n
LOT / BLOCK L ADDITION c y ry P, I. PID
OWN ER /t�. i t Mlfl 1. (Phone) l `2 —! . / /2— <751,5 (Address) I r
�7se I ■ tr i r a r * j
BUILDER • ii (Company Name) i 't#►)4 1 ) r AL. - L • (Phone) ° 1- �7 13
(Contact Name) J0 r.. -+ -L Roze_^e__ .. (Phone) _ g / Z' 3 46 - 6. Z &'
(Address) Z Z. 7( /'S / ye.– ,e /Y\ (t (ate D y
TYPE OF WORK ❑ Ncw Construction :Week ❑porch Re-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑UtilityConnection
CODE: EII.R.C. ❑I.B.C, C7 Misc. -- ✓ . -
Type of Construction: I II III IV V A B PROJECT COST /VALUE S a
Occupancy Group: A B E F HI M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 liavc tarnished tnfiu matron on this application which 1s to the best of my knowledge true and correct. 1 also certify that I am the owner ur authorized agent for the
a ed pn+perty 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 building
o - ial can rev c this permit for st r p ayse• Furthetmore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
I. Signature Contractor's License No. Date
Permit'aluation Park Support Pee # $
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 1 $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 7& r 0 0
This Application Becomes Your Building Permit When Approved Paid ,V ' Receis Ari!Jr`A.'=
Date 7a tt...e By
Building Official Date
— 'rhos o to certify that the reiplesr in the above application and accompanying documents is to acc with the City Zoning Ordiniince iurJ may proceed as requested. Tits document
when signed by the City Flamm ! eon,onues a rempurmy Certificate or zoning compliance and allowe eonsintction it commence. Before occupancy, A Ccraneatc or Occupancy mutt be
issued
Planning Director Date Special Condilipnn, if any
24 hour nnfice for all inspettimot (952) 441-9850. fax (952) 447 - 1245
4646 Dakota Street Prior Lake, MN 55372
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Ate
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