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fPRl'oCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.1.0c- TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
m AND UTILITY CONNECTION PERMIT
41/vNEsoll• I. White File
z. Pink City
PERMIT NO. 1 (a o
ZONING(office use)ZS7
3 Yellow Applicant
lease type or print and sign at bottom)
ADDRESS
5q �{ � ( e �n 54/ 44,t $ E
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER DQ id
k0U -f /
(Name) Q n (Phone) G 5-i 2 L( 5 . 9/ 7 7
(Address) 5 g tiC) I(.e b i h 5111‘ Q t 1 5 E
BUILDER
(Company Name) THD At- Home Service, Inc,
2690 Cumberland Pkwy, Ste 300 (Phone) J D di
(Contact Name) (Phone) 952/3 '1S- 66V /
Atlanta, GA 30339-3913
(Address) Lic#CR268257 Ph. 763/542-8826
TYPE OF WORK ❑New Construction ❑Deck ['Porch ❑Re-Roofing `�Re-Siding Clower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection ' `/ A/j y (f�of Iv ph u I» 'n f)"
ti;0
CODE: ❑I.R.C. ❑I.B.C. 0 Misc. t Y! ,)A,n? 0ØJ n,n� P. 3 i d• n q-/d n
ype of Construction: I II III IV V A B / 1 �e L
ccupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ )
ivision: I 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
official can revoke rjus cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Ni L_ / �, CRa4% as7 (112lI6
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 # $
PIumbing Permit Fee $ Water Tower Fee ## $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 1 b
This Application Becomes Your Building Permit When Approved Paid 0 , V V
Rec4130t No. 4130Date 4 . :.1(i By
Building Official Date
s rs ceti ht the biod em op is ce wZoningOrdinance moaiqudhidm
en signedto byrtify thethat Citye Planner reueconstitutesinhaove a applicattemporaryn Certificate
accoofpaZoningingdoccompliance ments andin allowsaccordanconstruithcttheionCity to commence.OrdinanBefore occupancy,andaypra Certificate oestef Occupancy. Ts ocu
must beent
fif.sued.
Planning Director Date Special Conditions,-if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372