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o F PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �'�� Z.�
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M��'NES��P �. Wh��e File pERMIT NO.
2. Pink City /� _ � �
. 3 Yellow Applicant �
Please e or rint and si at bottom)
ADDRESS � � � ZONING (ott'ice use)
3 S 3 Y /'?Q � s�1 S-�� e_.c
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owr�R � p h c�' G�J c s p s7la� 7- Y
(Name) (Phone) ! 3 5 7
(Address) .7 0 3� , I a� S'• S ��'� N W
BiJII.DER THD At- Home Service, Inc,
(Company Name)_ (Phone)
2690 Cumberland Pkwy, Ste 300
(Contact Name) _ Atlanta, GA 30339-3913 (Phone)
(Address) Lic # 20268257 Ph. 763/542-8826
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish Fireplace
❑Addition ❑Alteration ❑Utility Connection ^
CODE: ❑I.R.C. ❑I.B.C. 0 Misc. � � � � n �� / � � a � � � � S
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $ // v`�
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have farnished information on this application which is to the best of my knowledge tnie and cottect. I also certify that I am the owncr or authonzcd agent for the
above-mennoned property and that all construction 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 this permit for just c< �s Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to perform necded inspe tions.
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Signature Conuactor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 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 DiJE $
1
This Application Becomes Your Building Pernut When Approved Paid Rece' o.
Date . 2� B
Buildin � Otticial 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 requcstcd. This document
when signed by the Ciry Planner constitutcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificam of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372