HomeMy WebLinkAboutDemolition Permit 94-0008 � -,
O pRl �h'� ��� D ��` CITY OF PRIOR LAKE
� �� � '` 3 M LITI N PERMIT i: a� - a
v , rn S E P —� I� O O ry
3. Yellow - Applicant
Permit No. � 7 ��
DIRECTIONS 1. DATE 9.-- p— 9y BUILDING INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN 7. SIZE OF STRUCTUR
BEFORE PERMIT ISSUED 7�'y �(
(Please print or rype and sign at bottom). 8. NO.OF STORIES
2. SffE ADDRESS 9. TYPE OF CONSTRUCTI
S3 �/ �r�r� z P� �� S�
3. LEGAL DESCRIPTION
LOT _,� BLOCK PID ��� O Z IO ° O�J '� O 10. COMPLETION DATE
ADDITION F� �f 'Q� �• l// ! �
4. g� MER (Name) (Address) p el. No.)
[Sr'`� �N M• D�a�-s �'," �ro2�/ �✓• /s'� t.- s.� A�P/c Uo� l� / r �� S/.3/- f/3�- ,
5. AR (Name) ) (Address) (fel. No.) /_�/ / �
/l Cn .S/''� � f ii �� O �i/P �nh t Lc�¢� �p��C (�pt /�!� /�9/�.' �-? �� (Y X.,�to
6. CCaNTRACTOR (Name (Address) � � (fel. No.)
���, s,�,; t� C s�r� � Rs ��a ��
I hereby certify I have furnished inform+ � '-` —��'�^^�����nA true and correct. I also certify that I am the
owner or authorized agen or the above will conform to all existing state and local laws
and will proceed in acco ance with su CLOSED DUE TO I official can revoke this permit for just cause.
Furthermore, I hereby gree that the < �ACTIVITY 8/30/O1 he property to perform needed inspections.
X �-P�9�
Signature Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION / ` a.�.�.ti MATERIAL FILED WITH APPLICATION
O Site Resroration Plan
O U61ity Abandonment Plan
O Sewer Abandonment
USE OF BUILDING SfTE RESTORATION PLAN O WaterAbandonment
A.aAiV� Accepted by O Electrical Abandonment
Rejected by �Other i �n � i W i t��.
CREDITS �� gr � �'""' � � •�
TYPE OF CONSTRUCTION: I II III IV V� Park Ded. Credit ................................................ $ '�"�
SAC Credit ......................................................... $ �a
O�ccupancy Group A B E I H R M �
Sewer & Water Connec. Fee Credit °�
.................. $
Division 1 2 3 4
Water Tower Fee Credit .....................................$ �o ��
Other .................................................................. $
This ' d become our TOTAL CREDITS ��+ �
de liti it when ........................ $
.� /
By Date (� 2�' Issued by �� DaQe ^ Z�
This is to certi e request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
ma procee sted.
�:Whaaw C�a�Gi ax l " �
City Planne D e Special Conditions if any
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