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o� pR � d �P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZOIVING CUMPLIANCE G , J ,
�' � AND UTILITY CONNECTION PERMIT � r� ���� Z---
��NN�sot� .
'�'"""` F'� PERMIT NO.
Z. Pmk Chy I� .� C 3�
3. Ydlow AppliaM
OP dIId S[ bt�CDm
ADDRESS ZOI�TING t�«,�>
16536 Spring Avemue SW
LEGAL DESCRIPTION (oSSce use oniy)
LOT BLOCK ADDITION PID
O ER g�dy Dement & Mike Lambert (Phone) 612 226-3129
ame
�Address� 16536 Spring Avenue SW
BUII.DER
��� Buildets and Remodelers �� 612 827-5481
(Contact Name) NO�' Coffer � 612 827-5481
(p�) 3517 Hennepin Avenue South Minneapolis, MN 55408
�r�rnE oF woRx o x�,. c�� pn� or�n C�-�ss o�-s�
pL� I,e�ea F;mse O Finplaoe Oaad�oa Onlaraa� pva�icy connection
p �+�isc. rxo�c'r c�r�tnr.vE taoa�os � s $6900.00
I hereby oeidFy mat I have rumisnea iaformatian as tlris appiicarion wl�h is to me dac of my tnowka�e ome ana oomax. i aiso «xtifr tl�ac I am Bu owner ac�
autRorized a�mc for the � pmpeRy and thac au canstnux�ia, wiu confonm m au e�ting sta�e and locat laws and w;tt proaeed in aocordance wim
au6mit�d plans. I am awarc dut the buil�ng o6xtial can nevoke this prrmit for ju�t canse. Funhamore, I he�eby a�++ee that the ary offiaal or a desi�oee may
aiber upan the propeity ia �.
X �_ � BC1100 7/19/12
Conuactor's Lianse No. Date
Permit Valuatia� Park Support Fce # S
Petrnit Fee S SAC # S
Plan Chxk Fee S Wata M�ter Size 5/S"; 1"; S
s�� s� a P�s„re x�au«� a
�cy S c�cy sAC �►a wAC # s
Plumbing Peanit Fee S Watet Tower Fee # S
Mechanic�l Pennit Fee a s�au�s n�� a
Sewer & Water Permit Fee E Orher S
Gas Fireglace Parnit Fee S TOTAL DUE S
This Applicatioa Beoomes Yatr Bm'6� Pamit W6�dt Appmred Peid ' NO.
Da�te ?_ 11-F� /
sw o�t n�
'this is co mni[r mu due n�t in the aboMC app�on and � ean,m� a io aaaidma.rith me Cur ����r P� as ie+quaeM. 1'his dowmrnc
w+heu si�oed b9 tlx iSy � o�a a temPa+�7 Cec�e afi' 7.00io� cam�plima ard a0aws aomu�utma to corommce. Before omepaory. a Catierix otOaupancy aa�at be
i�aed.
Pta�u�g �ce�ar Dm�te Speaal Caditions, if anY
1�A 6air notke for all iospeaioas (9SZ1447- fas (95 )�7-4?�4S
16200 Eagle Crcek Avenue Prior [.ake, MN SS372