HomeMy WebLinkAboutDemolition Permit 94-0005 D ���a� c ,�-,
oF pR ' O R r CITY OF PRIOR LAKE
� � � DEMOLITION PERMIT i: si�e - c ry
U �� 3. Yellow - Applicant
' � '"' Permit No� �"�
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DIRECTiONS 1. DATE Bl11LDiNG INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN 7. SIZE OF STRUCTURE
BEFORE PERMIT ISSUED
(Please print or rype and sign at bottom). �_/ .,. 8. NO.OF STORIES
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2. SIT DAR � t �� 9. TYPE OF CONSTRUCTION
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3. LEGAL DESC PTION
LOT �LOCK � PID � � ��� �� �-'-� 10. COMPLETIONDATE
ADDITION / .� �' Ig !I7/ t�(/f� �/ �
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4. OWNER (Name) (Address� (Tel, No.)
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5. AR ECT (Name) (Address� (fel. No.)
6. CONT CTOR (Name) (Address) (fel. No.)
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I hereby certify I h e 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 procee in accordance with s ted plans. I am aware that the building official can revoke this permit for just cause.
Furthermore, ereb agree that th ci official or a designee may enter upon the property to perform needed inspections.
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Signature a�e
CLOSED DLTE TO
IlVACTIVITY 8/30/O1
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METRO SAC UNIT DETERMINATtON --� - 'ERIAL FILED WITH APPUCATiON
Site Restoration Plan
.� � � O Utility Abandonment Plan
O Sewer Abandonment
USE OF BUILDING SITE RESTORATION PLAN O WaterAbandonment
S l Cr F�� Acoepted by O Electrical Abandonment
Rejected by (� O Other 1� "- �
CREDITS ���`�'—�'-�� � �Y�
Park Ded. Credit $ �e��
TYPE OF CONSTRUCTION: I II III IV � ""'•"""""""""""""""""'°""'
Occupancy Group A B E I H R M SAC Credit ......................................................... $��
Sewer & Water Connec. Fee Credit .................. $�- �.� e
Division 1 2 3 4
Water Tower Fee Credft .....................................$ �c�c� - e
Other .............. .................................................. $
This applica o becomes your OTAL CREDITS $'� �
demolition mitw napproved ������������������������ �
By Date ��� �� Issued by Date��l —
This is to c ify that the request iri the above and acco anying document§ is in accordance with the City Zoning Ordinance and
m pr c as reques
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City P r Date Special Conditions if any
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