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4r CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,.,: TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT $79.75
NES6I
I.White File
2. Pink City I PERMIT NO. /, Z 9e
3.Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS
16824 Westbury Ave. Prior Lake, MN 55372
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION / PID
OWNER Tim/Lauri Ryan952-447-3687
(Name) (Phone)
(Address) 16824 Westbury Ave
BUILDER Custom Remodelers, Inc. (651)784-2646
(Company Name) (Phone)
(Contact Name)
(Phone) (651)784-2646
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK ❑New Construction :Peck ['Porch ❑Re-Roofing DRe-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
8 Window and 2 Patio Door Replacements
CODE: ❑I.R.C. ❑I.B.C. QMisc:
Type of Construction: I II III IV V A B 11,430.00
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify t I have furnished' forma,'on 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 property and that t co ' ction conform to 1 existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can rearilerfor .t ca . + .r• I her . a ee that the city official or a designee may enter upon the property to perform needed inspections.
V ��i �'., CR001748 April 1st 2015
X / Date
gnature , Contractor's License No.
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 $
`'Id I ���
This Application Becomes Your Building Permit When Approved Paid i / Rece. No.
I Date 4(, 7.r:� 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 Certificate req ested This
dmust be
ocument
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, P cy
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