HomeMy WebLinkAboutBuilding 03-1184
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
~.
Permit No. ()3 -/ / e4--
DIRECTIONS
1. DATE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
9- S. 07
BUILDING INFORMATION
7. SIZE OF STRUCTURE
8. NO. OF STORIES
2. SITE ADDRESS
/ G 450 /1 /V' /l/ /I
LOT
BLOCK
7l8/'1/ l-
25,902-. 03!), 0
9. TYPE OF CONSTRUCTION
3. LEGAL DESCRIPTION
10. COMPLETION DATE
PID
ADDITION
4. OWNER (Name)
(Address)
(Tel. No.)
5. ARCHITECT (Name)
e (I ~ Ct.J1f\.Pl'fVr'
CONTRA OR (Name) I
".1:NL
(Address) I^N (Tel. No.)
14.0DD V54:r p~ 1J.olJ)! t, ~A/mt!:f /1#11'16: NI(AL (J~ ,7)
(Address) (Tel. No.) 7b]-f18.;". J,) "I do
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 proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furthermore, I hereb agree that the city official or a designee may enter upon the proper to erform needed inspections.
Ignature
x
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
MATERIAL FILED WITH APPLICATION
o Site Restoration Plan
o Utility Abandonment Plan
o Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
o Water Abandonment
Accepted by
Rejected by
o Electrical Abandonment
o Other
Occupancy Group A
B
E
M
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other.............. ......... ............ ................_..... ......... $
TOTAL CREDITS ........................ $
TYPE OF CONSTRUCTION:
II
III
H
IV
R
V
Division
2
3
4
This application becomes your
demolition permit when approved
BY~ ~ Date ;f/~~3
Issued by
Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m<;y proceeq a~ re ues d.
q 6.0?:J
Date
Special Conditions if any
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