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�Q� � P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� T E M P O R A R Y C E R T I F I C A T E O F Z O 1� T I N G C O M P L I A N C E
L "'' �'���' AND UTILITY CONNECTION PERNIIT
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1. Whice File PERMIT NO . /�`� /_ S
2. Pink City
3. Yellow Applicant ( �f
Please e or rint and si n at bottom
ADDRESS 15467 Red Oaks Road ZONING �ot�ioe�se�
LEGAL DESCRIPTION (oflFce use only)
LOT BLOCK ADDITION PID
O WNER
(Name) Susan Crosbie (Phone) 952-447-2146
Address Site
BUILDER
(Company Name) Renewal By Andersen (Phone) _651-264-4777
(Contact Name) (Phone)
Address 1920 Coun Road "C" Wes Roseville, MN 55113
TYPE OF WORK Q New Construction [] Deck 0 Porch ❑Re-Roofing [�Re-Siding �Lower Level Finish ❑ Fireplace
[� Addition (� Alteration � Utility Connection
CODE: [] I.R.C. Q I.B.C. [] Misc Replace 7 windows 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 P�tOJECT COSTNALUE $_9,844.00
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished information on this application which is to the best of my knowledge true and correct. I also certify t6at I am the owner or suthorized agent for fhe
above-mentioned proper[y aad that all construction will conform to all exisring state and local laws and will proceed in accordance wit6 submitted plans. I am aware that the building
official can revoke this perm't or �ust cause. F ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X _ ,���_ 20130983 8/SEPT/11
Si ture Contractor's License No. Date
Permit aluaUOn Park Support Fee # $
Permit Fee SAC # $
an ec ee $ Water Meter Size 5/8"; 1 $
tate urc azge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
um ing ermrt ee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved • �
Buildin Official I�te
TLis is to certify that the request in the above application and accompanying documents is in accordance with the City Zouing Ordinance and may proceed as requested. Tlris documeM
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows conshvcHon to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Plannin DirecWr Date S 'al C�didons, if �