HomeMy WebLinkAboutDemolition Permit 95-0007 oF pR ' O �'� CITY OF PRIOR LAKE
� . 1. White - File
DEMOLITION PERMIT 2. s��e. --=-��ry
U m ��' �� 2 b#{�,��� 3. �f�llow - Applicant
1�7.7 f °'
r--
. `- '`'L-- _.____�i::-� Perm No. � �.
� �
DIRECTIONS 1. DATE BUILDING INFORMATION
7. SI2 OF RUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN �� ��� �j�� �
BEFORE PERMIT ISSUED / .S
(Please print or type and sign at bottom). B. NO.OF STORIES
�
2. SITE ADDRESS ��� � � �� �/ �/ 9. TY E OF C NST��CT� Q
3. LEGAL DESCRIPTI
10. COMPLETION DATE
LOT W t I � BLOCK � PID � �` �� �� _
ADDITION �L� �JI W v�- a r� �j/��/< S
4. OW F�R - (Name) (Address) J (' /�� (fel. No.) l
R��"K7�Y�� ���v��'\. ���� �r�i1Ll �JhqL-1r• lf0�' UGt�i��G
5. AfiCHITECT (Name) (Address) (Tel. No.)
6. CONT T (Name) Address) (fel. No.
_�[�� h C 1 [ � � KC a UGt�r K�i � � 7 � �Lr T �✓�t C/ � �/ 7 " .� �
I hereby certify I have furnished information whi is to the best of my knowledge true a d 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 proceed in acco e with submitted plans. I am aware that the building official can revoke this permit for j�st cause.
Furthermor , here a e that the ' official or a designee may enter upon the property t perform needed inspections.
X �" b
Signature ate
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION � �1�`- ��� v'� MATERIAL FILED WITH APPLICATION
O Site Restoration Plan
O Utiliry Abandonment Plan
O Sewer Abandonment
USE BUILDING SITE RESTORATION PLAN O WaterAbandonment
✓� .� w� Accepted by O Electrical Abandonment
Rejected by Q Other
CREDITS
TYPE OF CONSTRUCTION: I II III IV V� Park Ded. Credit ................................................ $ � 0
Occupancy Group A B E I H � M SAC Credit ......................................................... $ a- �
Sewer & Water Connec. Fee Credit .................. $ �,� oo�o .�s�
Division 1 2 3� 4
Water Tower Fee Credit .....................................$ 7� .�o
Other .................................................................. $
This appli ' comes your �
demolition it w en approved TOTAL CREDITS ........................ $ �3 �
Date Issued by Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed as requested.
City Planner Date Special Conditions if any