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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � AND UTILITY CONNECTION PERMIT
d ,
�'NES�
1. White File pERMIT NO . y
2. Pink Cily IZ� ���
3. Yellow Applican[
ease or ' t and si at bottom
ADDRESS ZONING (otrice use)
5085 Pondsed e
LEGAL DESCRIPTION (office use only)
LOT 6 BLOCK 1 ADDITION deerfield 8th add. P �
�� B r andon Cham (Phone) 612 - 3 2 8 5 3 4 5
(Address) 5085 Pondsedge
BiJII.DER Superior Exteriors MN Inc. 612-382-2549
(Company Name) (Phone)
(Contact Name) S t even E 1 i e (Phone) 612 - 3 8 2- 2 5 4 9
(Address) 4520 Tower St. Edina, MN 55424
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch [�2e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addirion ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Constrnction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 16 , 5 0 0
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 ]mowledge true and conect. I also cerufy that I am the owner or authorized agent for the
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 rev e' permit for just caus Furth ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x
BC639129 7/9/12
Signa Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
a< Plumbing Pernut 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 Bnilding Permit When Approved Paid Recei t o
Date B
su�ia�n Official Date please mail permit to home owner
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 honr notice for sll inspect[ons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372