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o � pRl CITY OF PRIOR LAKE BUILDING PERMTT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� x AND UTILITY CONNECTION PERMIT
U �
M ��'Ne5 0 �� � "'"°` F��° pERMIT NO. /,
2. Pink City �L .. �I 1
) Yellow Appliunt 0
P ase or ' t and si at bottom
ADDRESS ZONING (otnce use)
��Qs� shn�� ��a��
LEGAL DESCRIPTION (of'FFice use only)
LOT BLOCK ADDITION PID
OWNER l� 0 � S W!! r� Phone) I J� �! T l�i ' o� �� Y
(Name) �
(Address) � Y � ✓ ✓' + d `C / � Q !
g�,D�g THD At- Home Service, Inc,
(Company Name)_ 2690 Cumberland Pkwy, Ste 300 (Phone)
(Contact Name) _ Atlanta, GA 30339-3913 (Phone) g�a 3 y�' • G D V?
(Address) Lic # 20268257 Ph. 763/542-8826 J 0 c�,
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �Re•Siding ❑Lower Leve( Finish ❑ Firepiace
[7Addition �Alteradon ❑Utility Connection �Misc.
eODE: ❑I.R.C. [II.B.C. PROJECT COST/VALLTE S " s ��
Type of Constiuction: I II III IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U � Q � j , �/� � r+ `` � j u M , n
Division: 1 2 3 4 5 �
I hcreby certiry that I have furnished information on this apptication which is to the best of my knowledge true and coaect. I also ttrtify that 1 am the uwn�7 or authonzcd agent for the
above-mennoned propetty and tha[ all concauction will conform to ail existing state and local laws and will proceed in aecardanee with submitred plans. 1 am awarc that the building
uff 'a! can revo� ��ust aus . Fu�t� I hereby a�ce that the ciry official or a designee may enter upon the property to perform necded � ctions.
ao� ��a � s 7 7 �31��
Signature Contractor's Lianse No. Date
Permit Valuarion Pazk Support Fee # S
Pennit Fee S SAC # S
Ptan Check Fee S Water Meter Size 5/8"; 1"; S
State Surcharge S Pressure Reducer a
Penalty $ Sewer/Water Connection Fee # S
Plumbing Permit Fee $ Water Tower Fee # S
Mechanical Permit Fee S Builder's Deposit a
Sewer & Water Permit Fee $ Other �
Gas Fireplace Permit Fee S TOTAL DUE s . 7
Tiris Application Becomes Your Bnilding Perndt When Approved Paid ' Recei N
Date / B
Bui{din Ufficinl Date
Thu �s to certify that chc rcquest in the above application and aeeompanying documenu is in acc�dance with the Ciry Zoning Ordinance and may proceed as requ�xted. 7'his d�xument
when signed by the Ciry Planner consututes a temporary CMi6cate of Zoning compliance and allows conswction to commence. Before occupaney, a Certificate of Occupancy must be
issued.
planning pirector Date S'al Conditlons, ' ao
24 hour noNce for all inspections (9S2) 447-98 +0, tex (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372 .