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0 � YKIO� CITY OF PRIOR LAKE BUILDING PERMIT, �� ` l Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT
d �'¢�
'�'NES�
I. White File �7�7 1�T� � �� ��
2. Pink City LA1Vl lr � J
3. Yellow Applicant �
Please e or rint and si n at bottom
ADDRESS ZONING (ot� use)
15759 West Ave.
LEGAL DESCRIPTION (of�ice use only)
LOT BLOCK ADDITION PID
Na� Brian Burkart (Phone) 612-889-3794
��aares�) 15759 West Ave., Prior Lake, MN 55372 __� _
BUII.,DER
(Company Name) Lindus Construction, Inc (Phone) 715-684-4647
(Contact Name) Amy J Jilk (Phone) 715-684-4647
(Address) $79 Hwy 63, Baldwin, WI 54002
TYPE OF WORK ❑ New Conshuction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Constiuction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALiTE $ � � ���
Division: 1 2 3 4 5 (excluding land)
I hereby ceni at I have furnished ' formation 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-me one property and that co truction w'll conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c revo this pemvt for ju cau e. Fu e ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X � BC007644 10/25/12
S' ' ture Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water ivleier Siz� 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 DiJE $ . 7,�
This Application Becomes Your Building Permit When Approved Paid •� ReCei t N 7
Date � B
Buildin Officiai Date
This is to certify that the request in the above applicadon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consptutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Direcror Date Special Condirions, if any
24 hour notice for all inspeetions (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372