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-� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
477.1\ \ \c- TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" IL �� AND UTILITY CONNECTION PERMIT
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i. ink City
e File
2 Pink City PERMIT NO. / 3 // / 6,
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1 Yellow Applicant
Please or print and sign at bottom)
ADDRESS ) A re- h ZONING (office use)
/�P -5 Nd L l I
LEGAL I:)ESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER _ ~ n (` ,
(Name) — — � (Phone) �! "J Z / l �7�-�
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(Address)_ S
Budget Exteriors, Inc.
BUILDER 8017 Nicollet Ave. S
(Company Name) _ , (' Bloomington, MN 55420
(Contact Name 1 !. It. ANK_A■ J 952- 887 -1613 Fax: 952- 887 -1659
(Address) License # BC006564 Exp. Date:3/31/14
TYPE OF WORK ❑ New Construction ['Deck ['Porch DRe- Roofing DRe- Siding DLower Level Finish ❑ Fireplace
DAddition ['Alteration ['Utility Connection / /
CODE: ❑LR.C. ❑LB.C. V� ) r
Misc: / 1 . go /.0 ig-i--
Type of Construction: I II III IV V A B Q
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 4 tic `
Division: 1 2 3 4 5 (excluding land)
I hereby certify .. 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- mentione• ... and that all or ...n will co .. . to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offi ' revo e this permit for just ca • . F .. I h - by agree that the city official or a designee may enter u the property to perform needed • spe
/ 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 $ 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 $ &
7 y � s
This Application Becomes Your Building Permit When Approved Paid ' Z�� Recei , u . o 1
W'
Date By 4
Building Official Date
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
4646 Dakota Street S.E., Prior Lake, Minnesota 55372