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oF PR�O� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, � TEMPORARY CERTIFICATE QF ZONING COMPLIANCE
� X AND UTILITY CONNECTION PERMIT
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NHES° z ���� ��� PERMIT NO. f�._..IC% �j/�:
3 Yellow Applican�
Please or rint and si at bottom)
ADDRESS ZOIVING (ot�ice use)
/ G S a q� 70 / o n�o �-V �/? u.� s. �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
o�R p n�r z r t � c�����ra - o�ro �
(Name) (Phone)
(Address) � 4 � S �1 /� 0 j( t T v � �� / - / �S
BUII..DER THD At- Home Service Inc
(Company Name)_ 2690 Cumberland Pkwy, Ste 300 (Phone)
(Contact Name) _ Atlanta, GA 30339-3913 (Phone) � S%� �? y s- � O tJ 7
(Address)
Lic # 20268257 Ph. 763/542-8826 J e��
TYPE OF WORI� ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re•Siding ❑Lower Level Finis ❑ Fireplace
❑Addition ❑Alteration ❑UtiliryConnection 2�� ��/� �,,� �J a v M sn�.1
CODE ❑i.x.c. ❑t.s.c. 'El M;S�. � � � v > > �� 4 0 ,0 �*� 1 /� 4� /
Type of Constiuction: I II III IV V A B pROJECT COST/VALLTE $ �' 3 �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fiimished information on this application which is to the best uf my knowledge true and correct. 1 also certify that 1 am the owncr or authonzcd agcnt for thc
above-mennoned propc�ty and that all cunstruction will conform to all existing sWte and local laws and will proceed in accordantt with submitted plans. I am aware that the buildmg
official can revoke this permu for �i t c ue Funhermore, I hereby agree that the city official or a designee may enter upon the property to perform necdcd msp •cuons.
4 ��'��.-� �3 c� L S a s 7 �� 7 t�
Signature Contractor'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 $
Pena3ty $ 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 $ �' . 7
This Application Becomes Your Building Permit When Approved Paid ReCei t N.
Date B
Buildin � Utlicial Date
Th�s rs to certify that the requcst in the abuve applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA as requcsted. This document
whcn signed by the Ciry Planner conscitutcs a temporary Certificate of Zoning compliantt and alluws constnrction tu commence. Befure uccupancy, a Ccrt�ticate of Occupancy must be
issucd.
Planning Directot Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372