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( / �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1 30.11
., AND UTILITY CONNECTION PERMIT 1.
'� D Pink City ity I +� I. White File ` I , ( /
rNNESol PERMIT NO. I//
.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/508 3 P0,/) Roo o f SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 1_1(1,1901'y -- J O h n s o n (Phone) 95 /23 0 l S 7
(Address) / O 9 7 F S A PO //)7 *'d S
BUILDER THD At- Home Service, Inc,
(Company Name) 2690 Cumberland Pkwy, Ste 300 (Phone)
(Contact Name) Atlanta, GA 30339 -3913 (Phone) 4 5 / 7/ 3 S' S - G ° Y 7
�.J
(Address) Lie # 20268257 Ph. 763/542 -8826 o d'
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration DUtility Connection // G.► /, elO 14 rep/au/n.445
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. /4 / Y / n 1 , A op-1 /I/ /' g s S
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ / 3 9 . ` / 0
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have furnished Information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above - mentioned property and that 11 construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 amt aware that the building
off ial can revoke this permit for lu use Furthermore I hereby a that the city of ficial or a desi gnee may enter upon the property to perform needed mspcch •
a 8 25 7 �i�� Ql�/
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; I "; $
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 3' $ iq, - I r
This Application Becomes Your Building Permit When Approved Paid 11 Receipt No. to 1 �3 0
Date i 'L,1,, 1 1 Y.
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
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 he
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372