HomeMy WebLinkAboutDemolition Permit 95-0003 � oF� [� ��r, � � ��fr4tT1( OF PRIOR LAKE
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v , rn � DEMOLITION PERMIT 2. ai�e - c�ti
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� Permit No. ��\ " _l� �.3
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DIRECTIONS 1. DATE BUILDING INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN 7. SIZE OF STRUCTURE
BEFORE PERMIT ISSUED ti�k • 3� `X 34 �
(Please print or rype and sign at bottom). s�—�� . N . OF STORIES �
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2. S ADD ESS 9. TYPE OF CONSTRUC N
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3. LEGAL DE CRIPTION
10. COMPLETION OATE
LOT •� I Z�- BLOCK PID .� G
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ADDITION ��d l D� �� , .S C�7 7'7` l�0 �^�'�M � 5- l td �l a
4. OWNER (Name) (Address) (fel. No.)
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. A C TEC (Name) � � � � (Address) � ,{'6sI. No.) � _ � y � p
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6. C TRACTOR (Name) (Address) (fel. No.)
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i hereb y certify t have furnished information which is to the best of my knowledge true and correct. I also certify that I am ihe
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 he agr e that the city official or a designee may enter upon the property to perform needed inspections.
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� Signature Date
FOR ADMINISTRATIVE USE
METRO SAC UN1T DETERMINATION �- �� U�- � MATERIAL FtLED WITH APPLICATION
� Site Restoration Plan
�Utiliry Abandonment Plan
-�"Sewer Abandonment
US OF BUILDIN SITE RESTORATI N PLAN �WaterAbandonment
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�� � . Acoepted by ,�J ecVical Abandonment
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Rejected by O Other
CREDITS
TYPE OF CONSTRUCTION: I Il III IV VQ Park Ded. Credit ................................................ $ ���
Occupancy Group A B E I H Q M SAC Credit ......................................................... $ d�
Sewer & Water Connec. Fee Credit .................. $ a
Division 1 2 � 4
• Water Tower Fee Credit .....................................$ � �.�n,
Other .............. .................................................. $
This applica " n becomes your —�
demoliti r hen approved TOTAL CREDITS ........................ $ 3-�
By Date �'' � / � t �► Issued by Date `�� � / � �
This is to certify th the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m p d as re ed. '� �
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City Planner Date Special Conditions if any
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