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(4PR3N CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �-J / ! 7
J
LSO ) AND UTILITY CONNECTION PERMIT (o' I. White ie
C
2Pink City PERMIT NO. /4 7e7
.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
f $ 3 50ri /r)i nc ( le. /1/Id (I
LEGAL DESCRIPTION(office use only) �? F' I// '
LOT 7?BLOCK / ADDITIONS (1 /j ei ,: /--A 4T / PID R5-- 307- el/7-O
OWNER JQ ,.ry KuIACT/ CA (Phone) l
(Name) Phone G 02. 7 B 0
/
(Address) ` 41 g 8 3 3 Li /r, m !-z ('c e l L /1/1.1
W
BUILDER
(Company Nam THD At-Home Service, Inc, (Phone) 9 SP/3 I/$ ' 6 0 Si 7
(Contact Name) 2690 Cumberland Pkwy, Ste 300 (Phone) JoCl.
Atlanta, GA 30339-3913
(Address) Lic#CR268257 Ph. 763/542-8826
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DLR.C. ❑LB.C. NO Misc. / pa tir o oro o r /`e, l0 a M./r)
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ / B 5 7
Occupancy Group: ABE F HI MR SU (excluding land)
Division: I 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 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 use- Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
�� CRa4Sa s7 7 /15 /«r
Signature Contractor's License No. Date
Permit Valuation /A. r Park Support Fee # $ •
Permit Fee $ c�� 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 $ in /
Gas Fireplace Permit Fee $ TOTAL DUE $11 . 75
This Application Becomes Your Building Permit When Approved /J 1,-� Receipt Nol I g t.3
Da 1 I i 1 1 By 3 A '
Building Official Date C
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 document •
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