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of p: o4, CITY OF PRIOR E ,
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A, TEMPORARY CERTIFICATE
LAKOF ZONINGBUILDING COMPLIANCEPERMITQ....---- Date Recd
• AND UTILITY CONNECTION PERMIT
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I. White File I PERMIT NO. AAA
9(�
3 Pink City
(Please type or print and sign at bottom) 3 Yellow A litant 11I
DDRESS
1 �pO ^ C r` s �Q 1� ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
a
PID
OWNER r � n n [ .�[L
(Name) J6 l L f h U
/ (Phone) 7s b i 367 - S7 -2 a
(Address) 3 l( lc Si/b 4.4. e /' ( s C` "0,4 N 0
BUILDER THD At-Home Service, Inc
( Phone) Jo C
Company Name)
2690 Cumberland Pkwy, Ste 300 ( f,
(Contact Name) Atlanta, GA 30339-3913 /3 Ys • 6� Y 7
(Phone) ��:�!
(Address) Lic#CR268257 Ph. 763/542-8826
•
TYPE OF WORK 0 New Construction ❑Deck
❑Porch ❑Re-Roofing ORe-Siding ❑Lower Level Finish
DAddition Alteration ❑Utility Connection / W1 A Cr 0 10,7A ❑Fireplace
. CODE: ❑LR.C. I.B.C. ''`` fisc. tip/o c,/M IA 4a/yrr Ally opl4,fi1
Type of Construction: I II III IV
Occupancy Group: A B E F H I M R B
S U PROJECT COST/VALUE $ 5 5 7
")ivision: 1 2 3 4 5 (excluding land)
_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 constmction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
off
ignature'al can revokepermit for just aus Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
CR24 /4 '25' 7 gls lr �
Contractor's License No.
Date
Permit Valuation
Park Support Fee # $
Permit Fee $
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 $
Gas Fireplace Permit Fee $
TOTAL DUE $
This Application Becomes Your Building Permit When Approved
I Paid ' IS;.7.1 4PtNo. 2,4 ?Date y '` (Os.
Building Official Date `
j
Thu 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
wi
fld
1 Planning Director Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 Special Conditions,if any '
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4646 Dakota Street Prior Lake,MN 55372