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4 PRIpJP CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec(�'d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� (() /
- x AND UTILITY CONNECTION PERMIT
U tt
M1A'NEso�P
White File 2, Pink City PERMIT NO. /0 /04,6
3 Yellow Applicant
(Please type or print and sign at bottom)
4/ ZONING(office use)
ADDRESSL/ •-� q Q c ,4 e. [7- i v J:
7 O�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) / / 1 0 Cl 714 A n (Phone) 457(yy 5 - 7
9°V
(Address) /Y a 9 q 7i s h/ i- ,4 v t. N ,c
BUILDER (Phone)
(Company Name) THD At-Home Service, Inc,
(Contact Name) 2690 Cumberland Pkwy, Ste 300 (Phone) f 5 2/3'/G' • 1Ott 7
Atlanta, GA 30339-3913 J cd -EON. J o i1<S
(Address)
Licit 20268257 Ph. 763/512 8826
TYPE OF WORK ❑New Construction ❑Deck Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplac r�
['Addition ❑Alteration ['Utility Connection /R W I^do W PO P lip G n?/i
CODE: DI.R.C. ❑I.B.C. 0 Misc. IY I 1 7l'r I) bp1.4 '/)l S// U
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 1 2 6 /
Occupancy Group: A B E F H I M R S U (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 all constr ction 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 permi • justuse. ur ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspcctio s. . O
Signature
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 I $ TOTAL DUE / $ 79 75
This Application Becomes Your Building Permit When Approved Paid 71, 2f-- I • eipt No. 6'767.7
I
Date /(,, /O. ( U •. .
Building Official Date
This is to certify that the nce with the City
ning
ance
may
nt
when signed by the City Planner constitutuest in the es a tve emporary Ceication rt fcate of Zoning accompanying ocompliance andts is in allows construction to omm commence.
Before occupa occupancy,acCeditifrcat requested.
Occupancy trmust 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