HomeMy WebLinkAboutDemo 00-0046
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue . City
3. Yellow - Applicant
FEB - 4 2000
Permit No.
00 - L/- 6
.~CTIONS
1. DATE 1../4.- ( ()o
BUILDING INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom),
7, SIZE OF STRUCTURE
8, NO, OF STORIES
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2. SITE ADDHt:::SS 3
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3, LEGAL DESCRIPlION
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~ T(2. <S.tAJ. R.ISD
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9. TYPE OF CONSTRUCTION
10, COMPLETION DATE
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ADDITION 6Ej:~11.! Hr<'.
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4. OWNER (Name) '7 (Address)
[TeL No,)
,
5. ARCHITECT (Name) ^
6, CONTRACTOR (Name) -7
(Address)
(Tel. No.)
(Address)
(Tel. No,)
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 hereby agree that the city official or a designee may enter upon the property tOife orm nelded inspections,
X.", -' 7- 4-" /eJO
- Signature Daie I
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
MATERIAL FILED WITH APPLICATION
CI Site Restoration Plan
-r 1-\.1 ~ 'PE:;Q..N\ l""- Is I 5s U~ ~ T~~ CJ Utility Abandonment Plan
'6f;-i) (p ~ '-'t" ......-r't.. l't '22> !.VAS lS5v- s-.c To CJ Sewer Abandonment
U1L..A. ~..IL..oL-. I Ca..f.S,,-. 0 N '2-A 16~ RESTORATION PLAN l CJ Water Abandonment
ll'f~~ I (. . FoOT"...."'~-.J
-!-vA< V~ Cl>N ?.-f'!;; c9o. .... t'7"~by ~ CJ Electrical Abandonment
,. r-t ~ .....=~..vL-r
h:=>.:z...... As~Sot<... ONI'A~ectedbY CJ Other
-?A:-;.. "-H.'\IUo-(;-<) c:.HA~s-D ON f:(..l) Ji. l...--!+A!J.DITS I '~iJlI)' '
it::t1 "T{:~icrcofs"fRIc'fd;t r~~~~. II III IV V Park Ded, Gred~ .....~.. ............................,...... $ J .~g ~ <!l~ '
Occupancy Group A B E H R M SAC Cred~ ...........(3...1..............,..........1.......... $ -:i=t........,..
Sewer & Water Connec, Fee Cred~ e,. .......... $
Water Tower Fee Cred~ .....................,.....,.........$ _I
Other ....,........,....,......."...................,...........,...... $
TOTAL CREDITS ...,.......,............ $
Division
2
3
4
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I
Issued by
Date
In the above and accompanying documents is in accordance with the City Zoning Ordinance and
'2.<-{-CK)
Date
Special Conditions if any