HomeMy WebLinkAboutDemolition 99-0876
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3, Yellow ' Applicant
Perm~ No,!l9 -A'f~
DIRECTIONS
1. DATE "1/1<)"/'1'\
BUILDING INFORMATION
7, SIZE OF STRUqpRE
Z.300~+r
8, NO, OF STORIES
I
9, \XPE OF Cc;lNSTRUCTION
(~~~6--L-
10, COMPLETION DATE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
"'2.Si'fE ADDRESS ..-
'3"b 1"1 ?-.~.rJ/' I L\-t '-
3. LEGAL DESCRIPTION
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BLOCK
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(Namev
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S, ARCHITECT (Name)
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(Address)
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(Add.tss)
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s"", . P L f'\N
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nel. No.)
~7.- sqs .{.liJ)"(;,
(Tel. No,)
6, ClJ!"TF~CTOR (Na"le), (Address) (Tel. No,) ?
fJri'I'I~ Hou~ ~S< 6(. L. yt. ( ';) ~s..-
I hereby certilo/ 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 proc in ac nee with submitted plans, I am aware that the building official can revoke this permit for just cause,
Further e, agr e that the city official or a designee may enter upon the property to perform needed inspections,
7-1 ('f'Fi4
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Signature
x
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
MATERIAL FilED WITH APPLICATION
LJ Site Restoration Plan
Ll Utility Abandonment Plan
C1 Sewer Abandonment
USE OF BUilDING
'SFD
SITE RESTORATION PLAN
LJ Water Abandonment
E
Accepted by
Rejected by
II III IV <2
H fe M
2 4
o Electrical Abandonment
)lLOther N~"" H""",,- P'ODo~,,{
Occupancy Group A
B
CREDITS
Park Oed. Credit ............................,................... $
SAC Cred~ ..........................................,.............. $
Sewer & Water Connec. Fee Cred~ .................. $
Water Tower Fee Cred~ ..,...........,......................$
Other ...".............,.............,................,...........,.... $
TOTAL CREDITS ...............,........ $
TYPE OF CONSTRUCTION:
Division
Date
1- rf) -'17
,
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
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--City Planner Date Special Conditions if any
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