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X 04 - 7 ' � CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink city i PERMIT NO. / 0 . I D 76 1,/
t. Y
(Please type or print and sign at bottom)
ADDRESS 16456 Five Hawks Ave SE ZONING (ofiice use)
I
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) David Reis (Phone)
(Address)
BUILDER
(Company Name) ProBuilt America (Phone) 651 - 770 -9315
(Contact Name) Esther Dahl (Phone)
(Address) 2211 11th Ave E, N. St. Paul, MN 55109
TYPE OF WORK 0 Nevi Construction DDeek DPotch ]Its- Rooming 3Re Siding OLOsiftl Lt'el Finiah p Fireplace
DAddition DAiteration ['Utility Connection
CODE: OLR.C. 01.B.C. 0 Misc.
Type of Constntction: I 11 III IV V A B
Occupancy Group: A B E F 11 I M R S U PROJECT COST /VALUE S 8938
Division: 1 2 3 4 5 (excluding land)
I hmet y certify than I have T rther mti information on This application Thin is to The best of my 7mowledgc txne anti cunw. I also certify That I am the Droner at amnoriud agent fat me
above - mentioned property 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
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections,
X g0 Ord- 20356847 11/15/2010
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
I
Pumit 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 -7S—'
This Application Becomes Your Building Permit When Approved Paid - 77 , Z 1 / Recei o. Co i 7 rr
Date /!. !9. i0 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
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372