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tr. CITY OF PRIOR KE BUILDING PERMIT, Date Rec'd
AND
•
TEMPORARY CERTIFICALATE OF ZONING COMPLIANCE UTILITY CONNECTION PERMIT
9
44NEscie.
. Whitpinke Piie
C. I PERMIT NO. / e 078 I
(Please type or print and sign at bottom) 3 Yellow Applicant
ADDRESS 14112 BAYVIEW W CIRCLE. NE ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OW
(Name) DEB & KEITH RANDA (Phone)) 612( ) 202-7661
(Address) 14112 BAYVIEW CIRCLE NE PRIOR LAKE, MN 55372
BUILDER
(Company Name) SUPER SIDERS, a Winslow Company (Phone) (763) 497-5909
(Contact Name) Russell J. Winslow III (Phone) (612) 363-5364
(Address) 10533 Karston Avenue NE Albertville, MN 55301
TYPE OF WORK 0 New Construction ['Deck ❑Porch Re-Roofing
❑Addition ['Alterationg We-Siding [Rower Level Finish 0 Fireplace
❑Utility Connection
CODE: ®I.R.C. DI.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 $ 37,928.00
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have famished information on this application which is to the best of my knowledge tnie 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
otfici• is permit for just se Furthermore,I hereby agree that the city official or a designee may enter ro upon the
• P property to perform needed inspections.
Xa w`�LJ-r� BC-632296
re 9/29/2015
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 C� �� $
$ Sewer/Water Connection Fee # $
Water Tower Fee # $
PLEASE EMAIL ROOF ICE/WATER
Builder's Deposit $
PHOTOS TO Other
lallen@cityofpriorlake.com TOTAL DUE $
This Application Becomes Your Building Permit When Approved
Paid /S b. S Rec ' t No.
Date 9 29, L.S - By 1
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
24 hour notice for all inspections(952)447-9850 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372