HomeMy WebLinkAboutDemolition Permit 95-0006 �F PRIp�, �� ; f-, �-� �.- � CITY OF PRIOR LAKE
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DIRECTIONS 1. DATE/D �'`— BUILDING INFORMATtON
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN 7. SIZE OF STRUCTURE
BEFORE PERMIT ISSUED �t1 � �J3� " J
(Please print or type and sign at bottom). 8. NO.O � ORIES
2. SI E�� SS � ' � � �,_ ,�, ^� 9. TYP OF CONSTRUCTION
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3. LE AL DES RIPT ON /, /.,t/ j �
LOT BLOCK ' p�� �S � V�3 r V I"t �(.1 10. COM LETION DATE
ADDITION
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4. 9 �+ NER (Name) (Address) (fel. No.)
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5. A HCfEC7 (Name) (Address) (fei. No.)
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i hereby certify I have furnished information which is to the best of my knowledge true and orrect. I also certify that I am the
owner or authorized agent for the above mentioned property and that all construction will conform to atl 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 hereby agree that the city official or a designee may enter upon th�p ope y to� orm needed inspections.
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Signature Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION - /!1.`� S� � c.--��� MATERIAL FILED WITH APPLICATION
O Site Restoration Plan ;
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(�.��, 1�-�.,_o�,c.rc.� �p � � ����- v������s'� O DUIityAbandonmentPlan
O Sewer Abandonment
USE OF BUILDING SITE RESTORATlO PLAN D Water Abandonment
� c.� �\ Accepted by O Electrical Abandonment
Rejected by � O Other � G� � �
CREDITS - �� \ CR,�� J �
TYPE OF CONSTRUCTtON: I 11 III IV � Park Ded. Credit ................................................ $ �
Occupancy Group A B E I H � M
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $�
Division 1 2 � 4
Water Tower Fee Credit .....................................$
Other.................................................................. $
This appli n es your TAL CREDITS $ �
� demolition ' ved ........................
B Date ����-�� l, Issuedby Date 1�a: ��``
This ' ce ify that t e re uest in the above and accompanying documents is in accordance with the City Zoning Ordinance and
ma ro as requ ed.
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City Planner Date Special Conditions if any