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pF PR CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
0 AND UTILITY CONNECTION PERMIT 10/19/2012
4 /ktveso'i
1. in ke File
2 P (P ERMIT NO. . ink cty / / 3 "'�
(Please type or print and sign at bottom) Yellow Applicant al
ADDRESS
2535 SPRING LAKE ROAD ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
l BUILDER
(Company Name) KREUSER ROOFING 952,492.3842
(Contact Name) 3650 200TH STREET W . , JORDAN, M I NNESQM
(Address)
TYPE OF WORK ❑ New Construction ❑Deck � e- Roo
❑Alteration ❑ Uti � li y Connection
❑Re- Siding ❑Lower Level Finish ❑Fireplace
CODE: ❑I.R.C.
❑Addition h ,
❑ I.B.C.
❑ Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F I-I I MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I t
I hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and con I also certify that 1 am the owner or authorized agent for the
above - mentioned property and that all onstruction 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 revoke this permit for us ause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X l
Signature /0 ./r� (-L.__
Contractor's License No. Date
Permit Valuation
Permit Fee $
$2,500.00 Park Support Fee
Plan Check Fee $
74.75
5 SAC # $
$
Water Meter Size 5/8 "; 1"; $
State Surcharge $ 00
Pressure Reducer #
$
Penalty $
Sewer /Water Connection Fee # $
Plumbing Permit Fee $
$
Mechanical Permit Fee $
$
$
Sewer & Water Permit Fee $
Other #
Gas Fireplace Permit Fee $ Water Tower Fee
Builder's Deposit
TOTAL DUE $ /9./5
This Application a omes Your Building Permit When Approved I Pa ✓l 9 7S
I Re ipt No. 6 7_5-e.....6-- � ' / //2 ( Date /0 , / �/, / Z i
Bui Official Date
This is to certify at 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 he
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372