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04 PR/94, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
tiAN1 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
$79.75
drr
5pts/
I.White File PERMIT NO. /5-
z. Pink city --�e
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING Office use)
16109 Evanston Ave. Prior Lake, MN 55372
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Steve Johnson (Phone) 952-447-4388
(Address) 16109 Evanston Ave. 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 0 New Construction ODeck ❑Porch ORe-Roofing DRe-Siding ['Lower Level Finish 0 Fireplace
DAddition ❑Alteration ❑Utility Connection
CODE: DI.R.C. DI.B.C. plc: 1 Patio Door Replacement
Type of Construction: I H i IV V AB 4,239.00
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-menti ed property tall construction will conform to allexisting state and local laws and willproceed ino accordance with submitted plans. I am aware that the building
official ca evoke this pe t r•ust cause. F ore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ar% ei CR001748 Dec. 29th 2014
Sign 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 IVY'.
ceipt
Date
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 ay 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