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CITY OF PRIOR LAKE
DEMOLITION PERMIT
02.-(),3/0
DIRECTIONS
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bonom),
2, SITE ADDRESS /6:; / 02
3. LEGAL DESCRIPTION
1, White - File
2. Biue - City
3, Yeliow - Applicant
Permit No. 03./520
1, DATE
BUILDING INFORMATION
7. SIZE OF STRUCTURE
/1. /7. 0.3
8. NO. OF STORIES
9. TYPE OF CONSTRUCTION
L-rlK.85IPc /fV6Nl/b S.6.
10. COMPLETION DATE
LOT
BLOCK
PID Z5.0q(;.02-B.0
I hereby certify I have furnished information 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 pr eed in accord nce with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furtherm r . I hereby a ee t he city official or a designee may enter upon the property to erform needed inspections.
0.'3
ADDITION
L-AJC6SI06 PAle/<.
4. OW~ER (Name~
., \t' A14 A
5. ARCHITECT (Name)
(Address)
(Address)
6. CONTRACTOR (Name)
(Address)
x
(Tel. No.)
(Tel. No.)
(Tel. No.)
FOR ADMINISTRATIVE USE
/101 7. 0.3 .w.s; D()(). D 0 CH~ IN .s"'~e -
METRO SAC UNIT DETERMINATION MATERIAL FILED WITH APPLICATION
USE OF BUILDING
5,~D,
o Site Restoration Plan
o Utility Abandonment Plan
o Sewer Abandonment
SITE RESTORATION PLAN
Accepted by
Rejected by
II III IV Q)
H €) M
2 (!) 4
TYPE OF CONSTRUCTION:
Occupancy Group A
B E
Division
This application becomes your
demolition permit when approved
BY~ ~f.;
Date ///Ufo'3
o Water Abandonment
o Electrical Abandonment
o Other
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
TOTAL CREDITS ........................ $
RS"c , 8.(J
1'2... 7 $,ltO
1'2..00.8C1
7o(), CJO
Issued by
Date
11.91 Co
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
me;>' procee9 as !eques d. ~
~
"S (It,
Date
Special Conditions if any
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