HomeMy WebLinkAboutDemolition Permit 95-0005 t _.__..�.......... .. _.
•�oF � `'�� �_` r CITY OF PRIOR LAKE
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, � DEMOLITION PERMIT 2. ei�e . c�ri
U m '�` ;„� 2 3 I�y� 3. Yellow - Applicant
'','�`��-_._.._ _......�.� ��.- i Permit No. - .;.:
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DIRECTIONS 1. DATE �-� 9� BUILDING INFORMATION
SPACES NUMBEREb t THRU 10 MUST BE FILLED IN 7. SIZE �� UCTUf��
BEFORE PERMIT ISSUED G�' f
(Please print or rype and sign at bottom). 8. NO.OF ST� IES
2. SITE ADDRESS � O � � 9. TYPE OF CONS� TION
3. LEGAL DESCRIPTION 10. COMPLETION DATE
LOTS �I' 7a���'� BLOCK PID �S� l'�� ��
ADDITION �eJ(,(JA� �/T�i 1�� ll�Qie.- /.L�DG (O O�� � / �
4. OWNER (Name) (Address) (Tel. No
�/�E(3-�i �v �-�U� 4�P/yl �/✓f ,�N�, y`�O "340�
5. ARCHITECT (Name) (Address) (fel. No.) Q
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6. CONTRACTOF� (Name) (Address) el. No.) / `� �
�'i �vA- L C��2a-�� 58 q� m;1/�,e.. G' �Q �% . P;�� Lak� `�5�0 - �
I hereby certify I have furnished information which is to the best of my know edge 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 roceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furt mo , I hereb agree that the city official or a designee may enter upon the property to perform needed inspections.
X � � �- 7 9.s
Signature Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION ._l-- �`-- v� �� MATERIAL FILED WITH APPLICATION '
D Site Resroration Plan
.�_ - ✓� t -- ` U iJl�-- f O Utility Abandonment Plan
O Sewer Abandonment
USE OF BUILDI ,.._� SITE RESTORATION PLAN O Water Abandonment
✓t �= - ` t Accepted by O Electrica �A
Rejected by � C� O Other_-�` r t�c� ���
CREDITS
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TYPE OF CONSTRUCTION: I II III IV � Park Ded. Credft ................................................ $(�
Occ� anc Grou A B E I H R M SAC Credit ......................................................... $ �� �
P Y P �� o z,
Sewer & Water Connec. Fee Credit .................. $ �
Division 1 2 � 4 ,� �
Water Tower Fee Credit .....................................$
Other ....... .................................................. $
This applicati ecomes your REDITS
demoli6on n approved ........................ $
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By Date � L�' ��� Issued by Date G �
This ' to certi at the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m pro ee requ d. �
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City Plann Date Special Conditions if any