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04 PR , 1014003-Hanson
�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
N1 CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. white File PERMIT NO. .J ( V v
`�
3. Yellow Applicant
ase type or print and sign at bottom)
4F1
DRESS ZONING(office use)
17181 Horizon Trail SE.,Prior Lake,MN 55372 2. Pink City
/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Todd Hanson 612-750-6000-Cell
(Name) (Phone)
(Address) 17181 Horizon Trail SE.,Prior Lake
BUILDER
(Company Name) PCS Residential (Phone) 651-994-2028
(Contact Name) Pam Pomerenke (Phone) 651-255-0618
(Address) 2005 Pin Oak Drive, Eagan, MN 55122
TYPE OF WORK 9 New Construction ['Deck ❑Porch ❑Re-Roofing [ Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc:
lv
Type of Construction: I II III IV V AB Z y
cupancy Group: ABE F HI MR S U PROJECT COST/VALUE $18,279.00
%sion: 1 2 3 4 5 361
(excluding land)
I hereby certify that I have rnished 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-mentioned prope d that all con n 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 revoke t for just caus . ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X tom- f‘.4-r, 1 BC593158 11/5/2015
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 75.75 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 16-?S— Receipt No. 40,
Date I i^(Z-"6? By ��
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
en 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
ed.
1 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