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F pRio - CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
0
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 71 `I
a1, . AND UTILITY CONNECTION PERMIT '
9
1HNEs0-P I. White File /
2. Pink City PERMIT NO. /S- /9 /2
3 Yellow Applicant (�J
(Please type or print and sign at bottom)
ADDRESS ��II ZONING(office use)
0 (#a t S. A V (, C3 2-06
LEGAL DESCRIPTION office use only)
LOT B OC A e aITIO� PID 4276%*/gc5-0/lo—/
OWNER C �
(Name) G. (a / /) /L �L U l/V a S (Phone) ?s2/Y 110 • 31123
(Address) ! L Y 7 4 r/ Y C Ila tJ As A v, (...
BUILDER THD At- Home Service, Inc,
(Company Name)_ 2690 Cumberland Pkwy, Ste 300 (Phone) 9 S a C3 Y S • (i D V7
(Contact Name) _ Atlanta, GA 30339-3913 (Phone) d a di
(Address) Lic#CR268257 Ph. 763/542-8826
TYPE OF WORK ❑New Construction DDeck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑ ireplace
['Addition Addition Alteration ❑Utility Connection / pa /lc 4/� p /• / '4 4 u m 1/) r
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. /A 1), i j 1//) /f o P i n in
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ (•4 7 7i
Occupancy Group: A B E F H I M R SU
Division: 1 2 3 4 5 (excluding land)
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
offi 'al can revoke this permit for'List cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed mspec ons.
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CRa II2v7 t fSIf/ i
Signature Contractor's License No. Date
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Permit Valuation ei Park Support Fee # $
Permit Fee $ A d_ e SAC ## $
Plan Check Fee $ cWMeter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
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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 DUE $ /71' -1
This Application Becomes Your Building Permit When Approved • I Y I .� C Receipt No. c/
7 71
DateBy
l�k
- 171t �
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.
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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