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�� PRION
�, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Z. g AND UTILITY CONNECTION PERMIT 1 ' ?0 1 C
4,,
NEso
1.white Pile
2. Pink City PERMIT NO. j 5-cc
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
j c� ZONING
'((office use)
1�{`J o Surety UV He r"y
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ZS-3(/1,O/3_O
OWNER /
(Name) _. I Sart-\ r 1- ''.3-\c5�- (Phone)
(Address) I,`1 hd ft&)S r rsey L 1 ?a--10- 1
BUILDER �i 5 1 , 3q/_ Z
(Company Name) 151(�(J (-10e1(. IMP )\JET (EATT (i'l'I X t-K9 (Phone) �
(Contact Name) I PPN FI IX)NS (Phone)
(Address) -7)500 U1GIl--513JtzC-i W f' f 4 ?L'QiM O V-11.1 MN 59f
TYPE OF WORK 0 New Construction ❑Deck ['Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
['Addition RAlteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II III IV V A B �(
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ u 1
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-mentio .pr..erty 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 r . j i • 't fo st cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins ections.
X k63611-1 I Y)Ilb
Signature Contractor's License No. Date
Permit Valuation �Q®� Park Support Fee # $
Permit Fee $ s 1.—I SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Sa Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 5-1...s-co Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ gC lc
This ..lic tion Becomes Your Building Pe ' When Ap ved Paid C 7jReceipt No.
//� •,, ..-- Date ) '� By /114 /
.ut. _ • icial Date
This is to cethat the request in the above application and accompanyin.documents'.in accordance with the City Zoning Ordinance and may proceed as requested. This document
when Signe. / the•ty Planner constitutes a temporary Certificate of Zo ng compli. e and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. �
Planning 0 - tor 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
PRI0 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT z . / j, 13
just
4r�s�t+ Building contractor has pulled the permit this is what we will be doing.
9
Enclosed is the$25.00 fee for our License renewal for 2015.
!.arue F7+e PERMIT NO. / 55
2.Geld City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
14538 SURREY LN NE PRIOR LAKE MN 55372-1173
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Sarah &Curt Black
(Name) (Phone)
(Address) 14538 SURREY LN NE PRIOR LAKE MN 55372-1173
•
APPLICANT
(Name) DANA HOAGLAND PLUMBING INC (Phone) 952-935-5150
(Address) 410 REGENCY LN W HOPKINS MN 55343-3417
(Address) (City) (Zip Code)
(Contact Person) JAKE (Phone) 952-935-5150
APPLICANT SIGNATURE i DATE
2/6/2015
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
2 Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softener
3 Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(I or 2 compartment sink Sewage Ejector
1 Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
The Milinesota Statutes FEE SCHEDULE
§326B.Z•48 f joli cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended Residential,Additions&Alterations $49.50
The minimum surcharge for a
"fixed fee"permit is$5,00 $ Building Permit#
-PLUMBING PERMIT FEE $
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid PAiti
""®® •
Date p �7.VIT
Bultdine Oficial Date BOW
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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