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F � �, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
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,. wn��e File pERMIT NO. "
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3. Yellow Applicant
lease or rint and si at bottom
ADDRESS ZONING (ott�oe use)
5096 Pondsedge Lane
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 2 5 3 9 9 0 2 4 0
� Shynne Bloedel (Phone) 612-201-1285
(Address) 5096 Pondsedge Lane
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 Construcdon ❑Deck ❑Porch �lte-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration �Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B 14 , 9 0 0
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this applicarion which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-menrioned proper[y and that all construction ' conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke th' pe 't for just cause. Furth e, I ereby agree that the city oft'icial or a designee may enter upon the property to pert'orm needed inspections.
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BC639129 9/17/12
Signature Conuactor's License No. Date
Permit Valuarion Park Support Fee # $
Pernut Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State 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 $
This Applicadon Becomes Yow Building Permit When Approved Paid Recei t O.
Date B
Buildin Official Date please mail permit t0 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. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compflance 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 aR inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372