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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
T...) " AND UTILITY CONNECTION PERMIT /6 , /3, //
4 %A•a,Esott'
i. ink City
P ERMIT NO. /
. Pink City
3. // / L /
3. Yellow Applicant / l / / �
(Please type or print and sign at bottom)
ADDRESS
ZONING (office use)
5750 Fulbright Street SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Olive Hembrecht
(Phone) 952 447 -5078
(Address) 5750 Fulbright Street SE
•
BUILDER Builders and Remodelers
(Name) (Phone) 612 827 -5481
(Contact Name) Mary Anderson 612 827 -5481
(Phone)
(Address) 3517 Hennepin Ave South Minneapolis, mN 55408
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ' • ;, ' '.' 8 Li y�
�e- Siding
❑Lower Level Finish ❑ Fireplace ❑Addition fff ��'
❑Alteration ❑Utility Connection
❑ Misc. PROJECT COST/VALUE (exduding land) $ 13000.00
I hereby certify that I have furnished information on this application 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 - 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 revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the . roperty to perform needed inspections.
X l d, 0,4, ,//..,.. BC1100 10/12/2011
Signature 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 $ City SAC and WAC # $
Plumbing Permit 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 Building Permit When Approved Paid J q- 7J R �' ipt No. ‘'�- 7
Date /6 . 43,. // ,
Building Official Date
r
t
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 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Avenue Prior Lake, MN 55372