HomeMy WebLinkAboutDemolition Permit 95-0004 � E �, `.� .- ,._
O pR ��h' �` i I f������ ', � CITY OF PRIOR LAKE
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� + � � � � � � DEMOLITION PERMIT 2. si�e - c�
U , m � 3. Yellow - Applicant
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DIRECTIONS 1. DATE r'1.,.,�3 BUILDING INFORMATION
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SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN 7. SIZE OF STRUCTURE
BEFORE PERMIT ISSUED :2 0 k�O
(Please print or type and sign at bottom). 8. NO.OF�STORIES
2. SITE AD RESS ` 9. TYPE OF CONSTRi1CTtOW
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3. LEGAL DESCRIPTION
lOT B�OCK p� ,Z �—� �.�3 d� `a � �0. COMPLETION DATE
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ADDITION � �T� T - � .�L 4�� ....1—
4. OWNER (Name (Address} (Tel. No.)
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5. ARCHITECT (Na e) (Address) (fel. No.)
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6. CONTRACTOR (Name) (Address) (Tel. No.)
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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 afl 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.
Furt , hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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SignaWre Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION � �l��- U�-. � MATERIAL FIIED WtTH APPLICATION
�� �Site Restoration Plan
� � �'` � � �,� < � �blity Abandonment Plan
�wer Abandonment
USE OF BUILDING SITE RESTORATI LAN �ater Abandonment
�P�.�r��� ��v+- Accepted by �Electrical Abandonment
Rejected by O Other
CREDITS
TYPE OF CONSTRUCTION: I II III IV � Park Ded. Credit ................................................ $�� ���
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Occupancy Group A B E I H O M SAC Credit ......................................................... $ �� c
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Sewer & Water Connec. Fee Credit .................. $ f ��,
Division 1 2 � 4
Water Tower Fee Credft .....................................$ `7c�,
Other .................................................................. $
This applicati ecomes your L CREDITS _z:�
demolition p it n approved ........................ $ �
By Date ���-� Issued by Date ���� ,
This is to certify th th equest i� the above and accompanying documents is in accordance with the City Zoning Ordinance artd
may ed as re st . l
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City Planner � � r � �, �� ate� �S�cial Conditions if any 1 /'�,� ' ^ S.
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