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A '�� CITY OF PRIOR LAKE BUILDING PERMIT, V Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U 7, AND UTILITY CONNECTION PERMIT 0 , z O, ! b
A'N E So/
1. white File PERMIT NO.
//
2. Pink City J1 76 �7
3. Yellow Applicant Lam"
(Please type or print and sign at bottom) i
ADDRESS ZONING(office use)
(QI .1(40Ra;r AVQ—
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
Sri ft.lNK
OWNER Q
(Name) Pe I— I c l'-•\. ).< (Phone) / S - q --sc)-8C
(Address) qg0 bo—k - � T"C ZOI- <e Hi S&3 )
BUILDER �j
(Company Name) L- 5.-YIN-f) d-Heikej�C'ae=`X1)kCQ,, (�C-,(Phone) (Q
S o� - 93 --(�00
(Contact Name) c._,‘Ae ( He-1 h (Phone) /Sc - /33- 7306
(Address) / 13 Q3 Ex eel S 6r t v
k,-11.,s , i--9q Sc33
TYPE OF WORK 0 New Construction ❑Deck ['Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connectionio `
Type of❑l.R.C.Construct D.B.
pnB C I III HI IV V A B. isc: FU--el,.i. Cjtab\-QXYN. 0 6.,_.
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ A OM,
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
offici ca revoke this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date C.)' k(
Permit Valuation Park Support Fee # $ -1
Permit Fee $ 5•
v SAC # $
Plan Check Fee $ 1 7z '4( 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 $
This App Fa '• l: :uilding Permit When Appr ve Paid T Recei
�I �� . . �v. �o ecei��, (o/D�0
Date e. zO. /U By f •`F
,f.. ,
Buil ng i s ial Dat-
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
(cPRIp4
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41/NNEs60" Whlte -Building
Canary -tnginng
Pink -Planning
B DIN PRMT . P• I ATI•ND PAIT i l _
K.
NAME OF APPLICANT !-'v,.,,k
e i tf-r-17-- orz-V i iruc-
APPLICATION RECEIVED S Zo ,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
(tom (O I (/✓ ✓g
Accepted p Accepted With Corrections
Denied
fit 1 .
Reviewed By: ��
Date: 2 ,,
Comments: u�p�c Atakillt 'p v
<6 --r-A..,,,` 5 S. ( "A-C_
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"The issuance or granting of a permit or ait
computations shall not be construed to be a ermitf /
or, or an approvalal of plans, specificationsf, any and
any of the provisions of this code or of any other ordinance f the jur sd ctin.lo l Permitsof
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
��-� Pump & Meter Service, Inc
raj ail 11303 Excelsior Blvd
Hopkins, MN
P ' and M sem..IncPhone (952) 933-4800
UU-L141 Fax (952) 939-0418
MEMO
To: City of Prior Lake
4646 Dakota St SE
Prior Lake, MN 55372
Attn: Building Dept
Date: August 20, 2010
From: Cheryl Hein .
4/1 /IC, "
Ref: Sinclair
16176 Main Ave
Prior Lake, MN
Enclosed is (1)permit application and permit fee for the removal of the
fueling system at the above referenced site. Please forward permit to Pump
& Meter Service, Inc., 11303 Excelsior Blvd., Hopkins, MN 55343, Attn:
Cheryl Hein
Thank you
• Fueling Systems • Inventory Controls • Electronic Gauging •
• Fiberglass Tanks&Piping • Self-Sery Equipment •
• Compressors •Auto Lifts&Parts •
• Service Station Pumps •
1