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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIA CE q
�' AND UTILITY CONNECTION PERMIT q h / itr \ft! ,
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ADDRESS 4385 Fountain Hills Drive ZONING(office use)
Suite 301
Prior Lake MN
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Andy Chase
(Name) (Phone)
(Address)
BUILDER
(Company Name) Total Fire Protection (Phone) 605-582-2400
(Contact Name) Mark Pederson (Phone) 605-254-4974
(Address) 1004 7th Ave N Brandon SD 57005
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish El Fireplace
❑Addition ®Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. [ Misc: adding 16 fire sprinkler heads
Type of Construction: I II III IV V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 3,900.00
Division: 1 2 3 4 5 (excluding land)
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 reevokee is permit for just cause. Fur ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x a✓4 ''C C050 06/30/2014
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 103.00 SAC # $
Plan Check Fee $ 66.95 Water Meter Size 5/8"; 1"; $
State Surcharge $ 2.00 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 $ 171.95
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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