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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
7(, ~
Date
/0. /(,,(;
I White
2 Pink
3 Yellow
File
City
Applicant
I PERMIT NO. 0". 0 ?4-2. I
~ /I1LItI
L/v', /J.€.
S-S .3 72---
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER Gi
(Name) W-EG-
ZONING (office use)
.05"0.0
.s'CHt/ EN Pf3-t..-~
(Phone) '10 1-1/7--/2-7-0
(Address)
1../.06.
rz..-..--
S-S::s
BUILDER
(Name)
(Contact Name)
(Address)
:s>
I 1m ~d-t~
Iq~-z)6"~-ft> (;) If)
-
THD At-Home Services, Inc.
DBA The Home Depot Home Services
3200 Cobb Galleria Pkwy., #200
Atlanta, GA 30339 (763) 542-8826
LICENSE: #20268257
TYPE OF WORK
l1JRe- Roofing
DAlteration
o New Construction
ODeck
OPorch
OLower Level Finish
o Fireplace
OAddition
o Misc.
PROJECT COST/VALUE (excluding land) $
ORe-Siding
DUtility Connection
-
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 cause. Furthermore, I hereby agree that the city official or a designee may
;'7ili,pmp'rty"p~f~~""d'di_om :Ao ;). ft;l/t ;;b ~+ /0 /;.2 /0'"
Signature Contractor's License No. I Da~
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
#
#
Park Support Fee
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
#
#
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
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
16200 Eagle Creek Avenue Prior Lake, MN 55372