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°� PRj ��' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZOIVING COMPLIANCE
" _ � �' AND UTILITY CONNECTION PERMIT �� � � ���- • � �—'
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1. White File pERMIT NO . j � C..
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3. Yetlon� Appticant
lease ot rint and si at bottom
ADDRESS ZONING �o�c�,�)
17273 Wilderness Trail SE
LEGAL DESCRIPTION (ofif"ice use only)
LOT BLOCK ADDITION PID
OWNER
�� Craig & Emily Maiwurm (Ph�ne) �952) 226-6530
(Address) 17273 Wilderness Trail SE , Prior Lake, MN 55372
BUII,DER
(Company Name) J Z a c I n c. (Phone) � 7 b 3) 4 9 7— 4 4 4 4
(Contact Name) J e r r y Z a c h m a n (Phone) � � 6 3) 2 3 8— 4 0 51
(Address) 5249 0 ren Avenue NE Saint Michael MN 55376
TYPE OF WORK ❑ New Construction ODeck []Porch �Re-Roofing [,]Re-Siding �Lower Levei Finish ❑ Fireplace
DAddirion �Alteration ❑Utility Connecdon
CODE: �I.R.C. �I.B.C. ❑ Misc:
Type of Comsiiuction I II IlI N V A B �y�QD �
Occupancy Group: A B E F H I M R S U PBOJECT COST/VALUE S ��
Divigioa: 1 2 3 4 S (eacluding land)
I hereby ceitify rhat I have fiunished informaROn on this applicarion wftich is to the best af my Imowledge mu and correc[. I also certify that I am the owner or authoriud agmt for the
above-m 'oaed property and that aI! constxuction wil] mnform ro all ems[iag staue and local laws and will proceed iu accordance with submiaed plans. I am aware ihat the building
official oke ihis peimit fo ' . Furthecm , I hereby agec tbat the city offiaal or a designee may eater upon the property m perfoim needed inspecuons.
� BC593845 04/26/2012
ture Convactor's License No. Date
Permit Valuation Park Suppor[ Fee # $
Permit Fee $ SAC # $
PlanCheckFee $ WaterMeter SizeS/8"; 1"; $
S[ate Surcharge $ Pressure Rcducer $
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 S
T6is AppLication Becomes Yoar Buiiding Permit Whtn Approved Paid •�---- ei t No.
Date . � ?� •
Buildin� Official Date
This is to certify thac the request in the above applicaaoa and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as mques�rd This doc�ment
when sigaed by the City Planner constitures a temporary Certificate of Zoaing wmpliaace and allows consaucdon m commence. Before uccupaacy, a Ceitificate of Occupaacy must be
issued.
Pianning Director Date Special Conditious. ifa�•
24 T�onr noBce for ali inspecdons (952) 447-9850, fwr (95Zj �47-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372