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0� PRION (2— 2 1
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4,,,A N,ei\
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
rNNBS�'`Y $ 1 lG
• t.White Fite
2. Pink City 1 sj
(Please type or print and sign at bottom) 3.Yellow Applicant PERMIT NO.
ADDRESS ZONING(office use)
15170 Fairlawn Shore Trail. Prior Lake, MN 55372 12-1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID -Si 1 0o( "c4 03-7.0
OWNER Ron/Alice Determan 952-447-3692
- ) (Phone)
(Address) 15170 Fairlawn Shore Trail. Prior Lake, MN 55372
•
BUILDER Custom Remodelers, Inc. (651)784-2646
(Company Name) (Phone)
(Contact Name) Karli Biedermann (Phone) (651)784-2646
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK ❑New Construction ODeck DPorch Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: DI-R.C. DI.B.C. DMisc:
e of Construction: I II HIIV V AB 10,900.00
ccupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
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-mention property ant 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 can oke this permitst cause. urthermo �t> the city official or a designee may enter upon the property to perform needed inspections.
. x 4//I/1 (. CR001748 December 15th 2011
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 'l S SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ 1 L2N
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 c 7
This Application Becomes Your Building Permit When Approved Paid
"----n' '—'1‹, Receipt No. c
Date la • 1-1 - t By Q-,,, A_
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
hen 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
sued.
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