HomeMy WebLinkAboutDemolition Permit 95-0002 a +
O PR ��R �' ���� ���..�'� ���f OF PRIOR LAKE
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v m 3 1 � '� PERMIT 2. si�e - cry
, - ! `� a �9� i ! � j 3. Yellow - Applicant
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Permit No. � 5` b Z^
DIRECTIONS 1. DATE BUILDING INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN 7. SIZE STRUCTURE
BEFORE PERMIT ISSUED �I ��
(Please print or type and sign at bottom). ��,Z�/9� 8. NO.OF STOF�IES
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2. ITE ADDRESS 9. TY�F OF C�O� �R TION
S 0 � � t ��ri �i
3. LE AL DESCRIPTIO
2 10. COMPLETIOM DATE
LOT �7 BLOCK PID
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ADDITION ��I � h�/ ���� R� S 1/� �
4. OW ER (Name) (Address) (Tel. No.)
�{� N1 hs 1-�-� L.��A- j t�'/�11.� �5�� �f Z F(� l`�5`( � W �(- 7--,�� .� 5�
5. ARCHITECT (Name) (Address) (fel. No.)
6.� CONTRA�Ofl (Name) (Address) (fel. No.)
r._ � C � t�5 i�[��T i� � 5�ftJ[c�`s
I hereby certify I have furnished information which is to the best of my knowledge true and cor�ect. 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.
Further e, I hereby agree th the cit ffici or a designee may enter upon the property to perform needed inspections.
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Signa re Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION -� ��.- f' 'G� �� MATERIAL FILED WITH APPLICATION
,�Site ResWration Plan
�tility Abandonment Plan .
•�..Sewer Abandonment
US F BUILDING SITE RESTORATION PLAN '�WaterAbandonment
�r+� % �t, Acoepted by �Efectrical Abandonment
Rejected by O Other
CREDITS
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TYPE OF CONSTRUCTION: I II III IV � v, Park Ded. Credit �
Occu nc Grou A B E I H R M SAC Credit ......................................................... $ 1-�-
Pa Y P � �..
Sewer & Water Connec. Fee Credit .................. $ 0r�
Dlvlsion 1 2 � 4 y-
Water Tower Fee Credit .....................................$ ��
Other.................................................................. $
This appli ti n becomes your �p�'
demolition r en pproved TOTAL CREDITS ........................ $�_
By Date ;����� C� {ssued b Date � Z�� �
This i certify that th r quest in the above and accompanying documents is in accordance with the City Zoning Ordinance and
ma r d as reques
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City Planner Date Special Conditions if any