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\ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A NTEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r �� AND UTILITY CONNECTION PERMIT $79,75
NESD
I. white File PERMIT NO. �J C�'
2. Perk CiI—/ 1 �
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
16865 Lime Road SW. Prior Lake, MN 55372.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Gary/Betty McKinley (Phone) 952-447-3984
(Address) 16865 Lime Road SW. Prior Lake, MN 55372
BUILDER Custom Remodelers, Inc. (651)784-2646
(Company Name) (Phone)
(Contact Name) Karli Anderson (Phone) (651)784-2646
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DI.R.C. DI.B.C. �Misc.� 4 Window Replacements�� into existing openia
Type of Construction: I II III IV V AB ►W\S ` vi CI it.•�l 1qc•7,092.00
Occupancy Group: A B E F HI MR S U PROJECT COST/VALLIS'$ '
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 al;ent for the
above-mentioned property and that all..nstruction wil . form 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 jus, .use. F t.e .•. I her.. agree that the city official or a designee may enter upon the property to perform needed inspections.
x Karli Anderson 4� j / ,/ /,,j CR001748 Dec.10th 2014
' Signature IF 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 $ ,r
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 Application Becomes Your Building Permit When Approved Paid Receipt No.��•
Date By
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