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of PR1 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
41
:" TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
. AND UTILITY CONNECTION PERMIT l�• �'
41NNESO' f S Zl� • I. White File PERMIT NO. /Lir /� (L
�. f 2 7 2. Pink City �( r
U ( (�� 3 Yellow Applicant
(Please type or print and sign at botlbm)
ADDRESS /
6 $ 2 / 4 n U ZONING(office use)
9 0foII "1`o VL 3
LEGAL D RIPTION(o ce use only)
LOT BLOCK P - PID &5- qe --c910-
V
OWNER
(Name) Dan Prem( r (Phone) G12(2Y2 • 6 (40
(Address) / 4 $ 2 9 71 r O n/o 4v L S E
BUILDER THD At-Home Service, Inc, 952 l 3 Y S • G4' 7
(Company Name)_ 2690 Cumberland Pkwy, Ste 300 (Phone)
(Contact Name) _ Atlanta, GA 30339-3913 (Phone) J o di
(Address) Lie#CR268257 Ph. 763/542-8826
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplac
['Addition DAlteration ❑Utility Connection I p Cd ,n 0,014 0 (d ►u tr)IA 5 //)
CODE: ❑LR.C. ❑LB.C. ❑Misc. P V/1 /o f 0114/4 is
Type of Construction: I II III IV V A B 0 ��_3
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ •
Division: 1 2 3 4 5 (excluding land) I/4 0 t. 3 0 f fil
QQ.1 44x•33) CMArs iib Ue
3j '►f 30 /-
I hereby certify that I have furnished information on this application which is to the best of my knowledge true an con'ect. I also certify that I am the owner or authorized agen or 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 ca . irthe ore,I h eby agree that the city official or a designee may enter upon the property to perform needed
inspe tions.
GX CR26t217 (o�PD
l6/
Signature Contractor's License No. Date
•
Permit Valuation 1
i7S Park Support Fee # $
Permit Fee $ ` SAC # $
Plan Check Fee $ .5.(2-i),„.�" 7• /,c Water Meter Size 5/8"; 1"; $
State Surcharge $ _/\ Pressure Reducer $
Penalty $ 44 Sewer/Water Connection Fee # $
Plumbing Permit Fee $ j Water Tower Fee # $
Mechanical Permit Fee • $ Builder's Deposit $
Sewer&Water Permit Fee $ Other
Gas Fireplace Permit Fee $ TOTAL DUE $ /gl• 'Zs—
.
. This Application Becomes Your Building Permit When Approved • Paiet ,MI. S Receipt No. hid..Cif
Dae 0/24/ I By e
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 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
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