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64 PRIG.
�,� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ANTEMu bid PORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT it•1 5 IS
l*At B S°S
Ilk
3.Yellow n ,;�a„, PERMIT NO. /'j� lily
lease type or print and sign at bottom) 1. White File
2. lam` /
ADDRESS ZONING(office use)
16109 Evanston Ave. Prior Lake, MN 55372
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Steve Johnson 952-447-438
) (Phone)
(Address) 16109 Evanston Ave. Prior Lake, MN 55372
BUILDER Custom Remodelers, Inc.
(Company Name) (Phone) (651)784-2646
(Contact Name) Karli Anderson (651)784-2646
(Phone)
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK 0 New Construction ❑Deck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
❑Addition DAlteration ['Utility Connection
4i
CODE: ❑I.R.C. .B.c. ❑ 5 Window Replacements into existing openi�
Misc:
Type of Construction: I H III IV V A B
ccupancy Group: ❑IA B E F H I M R S U PROJECT COST/VALUE $ 8,593.00
.. ivision: 1 2 3 4 5 (excluding land)
. I hereby c--'fy that I have 'hed' ormation on this apply tion 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-in:f 4oned property nd that. ..n .. ction will confo to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c. revoke this. t=j Iause. u; =re,I here agree that the city official or a designee may enter upon the property to perform needed inspections.
x All ilti
CR001748 09-29-2015
Si:.ature 1111, 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 $ 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 Application Becomes Your Building Permit When Approved Paid 1(o 1 Receip NO 0 ly
• Date to1. („ i By l
Building Official Date
i nis to certify that the request in the above application and accompanying documents is in accordance with the CityZoning Ordinance and may proceed as requested. This document
hen signed by the CityPlanner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
Ili'
ued.
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