HomeMy WebLinkAboutDemo Permit 99-1272
CITY OF PRIOR LAKE
DEMOLITION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
1. White - File
2. Blue . City
3. Yellow - Applicant
Permit No. 9q- /272--
/
1. DATE to IZ-i !qct
,
BUILDING INFORMATION
7. SIZE OF STRUCTURE
8. NO. OF STORIES
2. SITEI\UUMl:SS 38 b8
3. LEGAL DESCRIPTION
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~ tfGrGt1"I5> '1f2,4/L.
PID~5-09t./- OOCJ-Q
6/Z-f5f57V H67G/T~
LOT
BLOCK
ADDITION
,e/..W
9. TYPE OF CONSTRUCTION
10. COMPLETION DATE
C (Tel. No.)
-J.E,
(Tel. No.)
4. OWNER (Name) .
~ Or:? l'-1c.z. 0AJ'-.i
5. ARCHITECT (Name)
(Address)
(b,U 13~~SWIC-~ Ave.
(Address)
(Address)
441 - B 'Z..C9
(Tel. No.)
6. CONTRACTOR(Name)~. .~
--=:> AYY1 <....-
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 all construction will conform to all existing state and local laws
andi:i11 roceed in ac. cordance. with submitted plans. I am aware that the building Offi.c.ial can revoke this permit for just cause.
Furthe ore, I here.ngr~~ ~he city official or a designee may enter upon the pr~pe".!)t to perform needed inspections.
X t~ ~~. -' ~_ dPV/' .:l./ /7519-
I / Signa~ Date ;
-"."
FOR ADMINISTRATIVE USE
~
~
15000. Ol:) C.o('>l o~ l..-e I'~ ~ rt: ~'L..6-0 I,
I"-J V Ac.Jc..-r J o6-M~,. ~ t..cJ 11.<- 1:> ,2.4'""' Ch
USE OF BUILDING (N C\~\ (Q 'NA\.- W~c.. SITE RESTORATION PLAN
D~o e>~ ND\I I l"ferj Accepted by
METRO SAC UNIT DETERMINATION
Rejected by
TYPE OF CONSTRUCTION:
II
IV
R
Occupancy Group A
B
E
III
H
Division
2
3
This appli ti n bec ~)l r .-
demoliti r' {j(j
By . Date
(0;:', ( 17
, , ,
CJ Sewer Abandonment
CJ Water Abandonment
CJ Electrical Abandonment
CJ Other
V
M
CREDITS
Park Oed. Credit ................................................ $ 650 ~
SAC Credit ......................................................... $ II!' ~o -
4
Sewer & Water Connec. Fee Credit .................. $ 17-c:>~-
Water Tower Fee Credit .....................................$ 1 t::> 0-
Other.... ............................. .............. ................... $
TOTAL CREDITS ........................ $
~ t> C:>fP -
Issued by
Date
~~~~:;ft t~~::t~~:uest in the above ~nd accompanying documents is in accordance with the City Zoning Ordinance and
r Lv#} , 'j.t/VAL) ;C/") d ~i "1
'--fIt PI~nn'er '~special Conditions if any