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•
04 PRI['
.� 4.e. CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ^
AND UTILITY CONNECTION PERMIT ,` ' (S
rN'� Esc .� $79.75
U
I. White File I PERMIT NO. /
z. Fax cry / �V/�9 I
3.Yellow A Lcant
(Please type or print and sign at bottom) �
ADDRESS
ZONING(office use)
16195 Lakeside Ave. Prior Lake, MN 55372 R ISL
LEGAL DESCRIPTION ffice use only
LOT BLOCK ADDITION ' '3 /f /0 ,,
. OWNER Al/Lori Edeker 952-220-2630
(Phone)
(Address) 16195 Lakeside Ave. Prior Lake, MN 55372
BUILDER
(Company Name) Custom Remodelers, Inc.
(Phone) (651)784-2646
(Contact Name) Karli Anderson
(Phone) (651)784-2646
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK 0 New Construction ['Deck ['PorchRe-Roofin
❑ g ['Re-Siding ['Lower Level Finish 0 Fireplace
['Addition Alteration ❑Utility Connection
CODE: DI.R.C. ❑I.B.c. 1 Window and 1 Patio Door Replacement
Type of Construction: I II III IV V AB ❑✓Misc:
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 7'000'00
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have .'shed 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 pro.- . 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 evoke this. [ r just cause. Furthermore,I hereby agree that the city official or a designee mayenter upon the property/ � Bn po pr to perform needed inspections.
X ' CR001748 June 2nd 2015
Signa e Contractor's License No. Date
Permit Valuation /j Park Support Fee ## $
Permit Fee $ f SAC # $
Plan Check Fee $ L Water Meter Size 5/8'; 1'
. $
State Surcharge $ Pressure Reducer $
Penalty $$$$
Sewer/Water Connection Fee ###
$
a:.
Plumbing Permit Fee $ �
Water Tower Fee ## $
Mechanical Permit Fee $ GI c Builder's Deposit $
Sewer&Water Permit Fee $ Other $ /
Gas Fireplace Permit Fee $ TOT UE $
e7q, "/_....
This Application Becomes Your Building Permit When A roved �� d 073
PP Pal /-- Receipt No. g
I Date �, � I BY ( ( I
Building Official CO
Date t.
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