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(<1PRCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT 5 g, l4�
M,NNESO�P I White File PERMIT NO. /
-- 332
Yellow Applicant t
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/7294 Sw'ir'a CtbCie S0� Prjoy- Lke....
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER �^• I ,}.�
. (Name) Sill aEJ h g ea ud a 1 e, (Phone) 9'52'22-06 , d/Oo
(Address) 172-94f 5ui'.lray 1. ircIe 5W� Prov- �ka.._ ym 55372—
DUILDEReOY1tira CFW J �,�"" ClInc_(Company Name) Sa n da rt,. �l sfiru�c fi� a I (Phone) 952 -90;-9/Do
(Contact Name) Ire vin SainclaGt._ (Phone) 02-'3e3'40lg-0
(Address)gg2y L jbl4ale Ave $, Qloom iki r)-)A) 55'l?-o
TYPE OF WORK ❑New Construction ❑Deck ❑Porch [Me-Roofing ❑Re-Siding ELower Level Finish ❑Fireplace
EAddition ❑Alteration ❑Utility Connection
CODE: D.R.C. ❑I.B.C. '54.Misc-1-Vi7b11 I replacement' p h'o door
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ .24/Y5:
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 tine and coned I also certify that I am the owner of authorized agent for the
above-mentioned property and that all construction will conform to all existing stlocal laws and will pioceed in accordance with submitted plans I am aware that the building
official yoke this pet for Just cause Fuitherm gre,I hereby agree tZtal
or a designee may enter upon the propelty to perform needed ions
� i1B C GV?2 5-1 5 inspc
9l/4
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 $ TOTAL DUE $
This Application Becomes Your Building Pennit When Approved Paid T! • iRe pt No. / 7 /-
Date _ Cif- / /---
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 pioceed as iequested This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence Befoie occupancy,a Ccitificatc 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
4646 Dakota Street Prior Lake,MN 55372