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PR j04.
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
AN1
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT $161 r �
jkN E S°�
I.white Pile /
PERMIT NO. 5 / !J
2. Pink City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING Office use)
14987 Appaloosa Trail NE. Prior Lake, MN 55372
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Arthur/Chris Keith (Phone) 952-440-1943
(Nam(Address) 14987 Appaloosa Trail NE. 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 ODeck ['Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Alteration ['Utility Connection p �� f /
CODE: ❑I.R.C. ❑I.B.C. Dm.: DOOR, SI p6(AT i I XA-1"f,SO 4 tYv114 Pay,"
Type of Construction: I II III IV V A B 12,290.00
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
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 co..truction 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 rev :e this permit four j . caus1. Furthermore,I her :' agree that the city official or a designee may enter upon the property to perform needed inspections.
X AM 1/ IA CR001748 January 30th 20'15
%nature gip 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 $ //
/
This Application Becomes Your Building Permit When Approved Paid /q, 7r Rece. t No. $/
Date Z ,ef-,f5- 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. Thi:,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