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`"p4 pRio (TEMPORARYp CITY OFCERTIFICAPRIOR LATKEE OF BUILDINGZONING PERMIT,COMPLIANCE
Date Recd
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AND UTILITY CONNECTION PERMIT $ 1 / '
1 v
�rrArivES° 1.wn;te File PERMIT NO. /�
3. ells Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS
3975 Pershing Street SW. Prior Lake, MN 55372 /�lS�
LEGAL% DESC' I'TION(office use only) a _ l a I O�
T'C�C' i�•C'/ /• i i ION 1/7/2.-
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OWNER Miguel Bou (Phone) 612-599-4864
(Name)
(Address)3975 Pershing Street SW. Prior Lake, MN 55372
BUILDERPhone) (651)784-2646
(Company Name)Custom Remodelers, Inc.Inc
(Contact Name) Karli Anderson
(Phone) (651)784-2646
(Address) 474 Apollo Drive. Lino Lakes, MN 55014
TYPE OF WORK ❑New Construction QDeck ['Re-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
o e 0 n
['Addition ['Alteration ['Utility
C
1 Entry Door Replacement/no structure char
CODE: EILR.C. DI.B.C.
OMisc:
Type of Construction: I II III P/ V A B PROJECT COST/VALUE $ 3,094.00
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
and correct. I also I am aware that the building
• I ove- ncertify that I have and th.edS oco .tion this application
n ono to all existing state and local knowledgeaws anwill eproceed in accordance i certify submitted plans.that I am the owner
or authorized agent for the
above-mentioned revo s per uponpropertyto perform needed inspections.
P official can revo is permit or' t ca J. 'urth ore,I here: agree that the city official or a designee may enter the June 30th 2015
/ / ii CR001748
XV / ' •,,,,, Contractor's License No. Date
` ture
Park Support Fee # $
Permit Valuation
Perm $ SAC # $it Fee � $
Plan Check Fee $ Water Meter Size 5/8";1";
�'1 t Pressure Reducer $
State Surcharge $ 1 O� $
$ Sewer/Water Connection Fee #
Penalty 1 # $
$ Water Tower Fee
Plumbing Permit Fee
Builder's Deposit $
Mechanical Permit Fee $ TOTAL DUE $ 'l$ n ....r/) , _/
Sewer&Water Permit Fee $ Other
Gas Fireplace Permit Fee $ �
5. 5 receipt No. ��I I
This Application Becomes Your Building Permit When Approved f�� y
Date 1 • /0.
5f
t Building Official Date t
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
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372