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0/4 PR,-. 1014034-Osterberg
A., CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
/U TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /Z. 3 (1--
AND UTILITY CONNECTION PERMIT
r4'NES° I. Wh�
Fie
2. n'ke Ci
Pty PERMIT NO. /5 �4.46-
3. Yellow Applicant •
e type or print and sign at bottom)
DRESS ZONING(office use)
17168 Horizon Trail SE.,Prior Lake,MN 55372
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
UWNEB.
Edwin "Skip"Osterberg
(Name) (Phone) 952-855-4885
(Address) 17168 Horizon Drive 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 ❑New Construction ['Deck ['Porch ❑Re-Roofing ['Re-Siding ELower Level Finish El Fireplace
❑Addition ['Alteration ['Utility Connection
41 ,
CODE: ❑I.R.C. ❑I.B.C. DlMise: 5 Full Window Replacement+
Type of Construction: I II III IV V AB
ccupancy Group: A B E F H I M R S U PROJECT COST/VALUE $9,280.00
isi on: 1 2 3 4 5 (excluding land)
i hereby certify that I..ve 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-mentioned pr,,, and that all construction ALconform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can reviiiii .ermit for just cause.• �T e• ,I hereby agreethe city official or a designee may enter upon the property to perform needed inspections.
Jr
Signature 'X Contractor's License No. BC593158 Date 12/2/2015
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 $C
This Application Becomes Your Building Permit When Approved Paid ` J j 1 R ipt No. 3 5 O
Date /Lr9 , � B
Building Official Date i j•
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
ed.
I 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