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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT ?. (3, (r
1.white File
2. Pink city PERMIT NO. /� ✓gp
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
6094 Marlen Circle, Prior Lake, MN 55372 R
LEGAL DESCRIPTION(office use only)
LOT7&8BLOCK001 ADDITION Green Oaks 2nd Addition PID 25127-0080
OWNER
(Name) Robert & Patty Hubbard (Phone) 612-860-6740
(Address) 6094 Marlen Circle, Prior Lake, MN 55372
BUILDER
(Company Name)Your Home Improvement Company (YHIC) (Phone) 320-230-9182 x61
(Contact Name) Jessica Weimer Email:jweimer@yhic.com (Phone) Fax: 320-230-9189
(Address)3900 Roosevelt Road, Suite 125, St. Cloud, MN 56301
TYPE OF WORK 0 New Cons' ;in ['Deck ['Porch ORe-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
['Addition :.Alteration ❑Utility Connection Replace: (1)entry door&(1)storm door. Install (1)entry door
CODE: DI.R.C. 0I.B.C. gMisc: &(1)storm door where there isn't one existing.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R SU PROJECT COST/VALUE $ 16,10$
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 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
officialcan revoke this permit for just cauuse. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x _cimac. - jai/0A _, for YHIC BC 506363 07/07/2015
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ tl SAC # $
Plan Check Fee $ J Water Meter Size 5/8";1"; $
State Surcharge $ 60 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 $ 07✓` 96"
This Application Becomes Your Building Permit When Approved ( / 'k 11
Pero (D ' S 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