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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ;; � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �' ��
y �'.
AND UTILITY CONNECTION PERMIT �" j
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M��'NESO�P �. wh��e File pERMIT NO. �. 3 �
2. Pink Ciry
i Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS ZONING (off'im use)
/ s�3 91 Rp al C� a�s Ro� S�"
LEGAL DESCRIPTION (ofl'ice use only)
LOT BLOCK ADDITION PID
OWNER � Q t ! / ( ,Q �.✓ � � � V d � � � (Phone) 9 7 7� T � � • � s � c7
(Address) � 7 3 (( �� U v a` S U Q� � J T
BUII.,DER THD At- Home Service, Inc,
(Company Name)_ 2690 Cumberland Pkwy, Ste 300 (Phone) �� al3 �$" L Ot j 7
(Contact Name) _ Atlanta, GA 30339-3913 (Phone) � � Gf 1
(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 ❑M,S�. / 7 W�ncl�w s �' �p�� �o or �'�p/�U ��s
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $ ��, r S 7
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that 1 have fi�mished information on this application which is to the best of my knowledge true and correct I also certify that 1 am the owner or authorized agent for the
above-mennoned property and th al conshuction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
uffi ial can revoke this permit r j st use. Fwthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspec ons.
aoa��a�� s� ali�
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 $
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 DLTE $
This Application Becomes Your Building Perntit When Approved Paid Re 1 t No. 3
Date r � C �
Buildim_ Otticial Date
This is ro certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner constitutcs a remporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificare of Occupancy must be
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