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4 � �R CIT'Y OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�'���.�_:�;` AND UTILITY CONNECTION PERMIT
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'`�'�� F �'� FERMIT NO. � I_ �1 C��
z. nnk c;ry
3. Yellrnv Applicant
Please e or rint and si n at bottom ,�,,,,_,
ADDRESS 15236 Edgewater Circle ZONING (ott'iceuse)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Jim Bickett (Phone) 952-447-1434
Address Site)
BUILDER
(Company Narne) Renewal By Andersen (Phone) _651-264-477'7
(Contact Name) (Phone)
Address 1920 Coun Road "C" West, Roseville, MN 55113
TYPE OF WORK Q New Construction [� Deck � Porch []Re-Roofing [�Re-Siding �Lower Level Finish ❑ Fireplace
[] Addition (� Alteration Q Utility Connection
CODE: Q LR.C. ❑ I.B.C. Q Misc Replace 1 Window, 1 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 $_2
Division: 1 2 3 4 5 (excluding land)
I hereby ceRify that I have furnished information on tlus application which is to the best of my knowladge true and correct. I also certify that I am the owaer or authorizod agent for tha
above-mentioned pr and that all con ion will conform to all existing state and local laws and will proceed in accordance with submitted plaas. I am awaze tltat the building
official can revoke ' rmit for just cau . F ermore, I hereby agree Wat the city o�cial or a desi�ee may enter upon the propeRy to perform needed inspections.
g 20130983 17/AUG/I 1
Si ture Contractor's License No. Date
Permit V uation Park Support Fee # $
Permit Fee $ SAC # $
P an Chec Fee $ Water Meter Size 5/8'; 1'; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plum mg 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 "
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Buildin Officiat Date
This is to certify that the request in the above application and accompaqying documents is in accordance with t6e City Zoning Ordinance and may proceed as requested. This document
when sigued by the City Planner constitutes a temporary CeRificate of Zoning compliance and allows con$Wction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Plaunin Director Date S 'al Co�ditions, if m�