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(PR!; CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCEAND UTILITY CONNECTION PERMIT 7 / 7 I!j
4.14,Ne8ott. I. White File
2 PinkCity PERMIT NO. it'
673
—
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
G2s2 Lo / iS , eft 4v. . SE ;.jIs.i._
LEGAL DESCRIPTION(office use only)
LOT BLOCS ADDITION ('?T-/('-6-7.0 e. /4- CA PID - ( (' --0/ - 0
OWNER 4Q /) / Wt ISO ` 1 S2X4/7` 9 '. /
(Name) (Phone) 7
(Address) / L S 2 Z Q & S / C'I L '4 V t'' S E
BUILDER THD At- Home Service, Inc, Jodi,
(Company Name)_ Inc (Phone) J QST �3Y •�' C y7
2690 Cumberland Pkwy, Ste 300
(Contact Name) _ Atlanta, GA 30339-3913 (Phone)
(Address) Lic#CR268257 Ph. 763/542-8826
TYPE OF WORK 0 New Construction ODeck ❑Porch ORe-Roofing Re-Siding ❑Lower Level Finisp D Fireplace
DAddition DAlteration DUtility Connection 9 w i n Cr'rO (,J Pe/Lau /1'194
CODE: DI.R.c. DI.B.C. 0 Misc. /1) A Vi J / 14 ti .# /I f f) 1
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ ?'/A 7
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that Il 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 rmit for jus ca a Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed in: ections.
/G __ \ - CRac '6as7 7 �% py
i1. Signature Contractor's License No. Date
((((Permit Valuation �J Park Support Fee # $
Permit Fee $ '` / f t 2 S SAC # $
Plan Check Fee $ ` ", Water Meter Size 5/8"; 1"; $
`
State Surcharge $ 6.) Pressure Reducer $
Penalty $ 000 Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
I •
Gas Fireplace Permit Fee $ TOTAL DUE $ '7 e. ?'sr
pp g Approvedi �� Receipt No. -7l�rC/ g
This Application Becomes Your Building Permit When pa���
Date"?r t; j // ( By /1
P ' ,,/>)....---2
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 d cument
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 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