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F � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO . l� 1/�� L
2. Pink City
3. Yellow Applicant ��
lease e or ' t and si at bottom
ADDRESS ZONING (o�t'ice use)
14183 Shore Lane NE
LEGAL DESCRIPTION (o£fice use only)
LOT BLOCK ADDITION PID 2 5 215 0 3 7 0
��W1�TER Joe Hartlein (Phone) 612-236-6288
ame
(Address) 14183 Shore Lane NE
BUII.,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 [�[te-Roofing ❑Re-Sidin� ❑Lower Level Finish ❑ Fireplace
❑Addiaon �Alteration �Urility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc: �
Type of Constraction: I II III IV V A B 10 , 0 0 0
Occupanty Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (exduding land)
I hereby certify that I have fumished informaaon on this application which is to the best of my knowledge true and conect. I aLso certify that I am the owner or authorized agent for the
above-mentioned property and that all mnstruction will conform to all existing state and local laws and will pmceed in accordance with submitted plans. I am aware that the building
official can revoke this 't for just cause. Furthexmo , I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ��' BC639129 10/1/12
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
Staxe Surchazge $ Pressure Reducer $
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 $ �i ""
This Application Becomes Your Building Permit When Approved Paid Recei N
Date B
su��a�o 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 pmceed as requested. 1'his document
when signed by the City Planner constltutes 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 hour notice for all inspecUons (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., PrIor Lake, Minnesota 55372