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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
LEGAL DESCRIPTION (office use only)
BLOCK
ADDITION
(Address)
White
Pink
3 Yellow
I PERMIT NO. (){,- o{,o11
File
City
Applicant
ZONING (office use)
PID
(Phone) (ClQ') ZZL:- S3QL
'"
BUILDER
(Company Name)
(Contact Name)
(Address)
:::lELA ROOFING & REMODELING, INC.
1100 EXCELSIOR 81 vn
ST. LOUIS PARK, MN 55416
10 #0001050
(Phone) jg~Z") q\S.{ZZLt
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch '&fRe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conneltidn D Misc.
CODE: DI.R.C. DI.B.c. PROJECT COST IV ALUE $ qISl\~
Type of Construction: I II III IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
I hereby certify that I have furnished mformatlon on this applicatIOn which IS to the best of my knowledge true and correct. I also certify that I am the owner or allthonzed agent for the
above-mentIOned property and that all construction will conform to all eXlstmg state and local laws and will proceed in accordance with submittcd plans I am aware that the buildmg
"fficia oke thIs ermit for J st cause Furthermore, I hereby agree that the CIty official or a designee may enter upon the property to perform needed mspectlOns
X i\~/DG
Contractor's License No. f Date
Permit Valuation f Z<)'(J 0, ~O
Permit Fee $ . 7,+. 7~
Plan Check Fee $ -
State Surcharge $ /.'2-$
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
I ~OITI~ 7A,&"
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7c',.oo
I paidJf~..e
Date I fLJ {()fp
I ~~ceipt N;;: 931
ThIS IS to cerl1fy that the request in the above applicatIOn and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested. ThIS d"cument
when signed by the City Planner constitutes a temporary Certificate of Zonmg compliance and allows construction to commence. Before occupancy, a Cerl1ficate "f Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372