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CITY OF PRIOR LAKE Date Rec d
DEMOLITION PERMIT ¢ r Jar
l`�'NES
PERMIT NO. /z ac is
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
9 ° e 0 /rv 9 0
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 25. 0 0 (_ iO4-. 0
OWNER
(Name) L' • (T7 a f Ao,e- - ii (Phone)
(Address) /
9)4 *(t/L- 445 e0(q
CONTRACTOR r��7��jj
(Company Name) 67A4/ h Z ti c 0 ; 4 ' C ..7 C (Phone) 9-Ca- X )3 - CJ
(Contact Name) /\ C6 i'>` (Phone)
(Address) p4:,) V? $f /SG/ as /e /il /"/e:.c..._ ..."4/ S'60 /(
Use of Building: INTERNATIONAL BUILDING CODE
Type of Construction: I H III IV ft A
56N G 4 4 , 5 " / `I/ / N 6 Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5
P MPCA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION
I hereby certify that I have furnished information on this application 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
and will oceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
I hereby e that the city official or a designee may enter upon the property to perform needed inspections.
C" V7 /&
• Signature Date
METRQ (MCE) SAC UNIT
_ This A . plication Becomes Your Demolition ,UE TERII� IIN ATION . v� ,. ,
/ Permit When Approved /
I.. :.�.5 / 7i
Building 0 i cia Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested.
Pi g Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
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" Site Restoration Proposal For Demolition
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Applicant: - 774.4
Address: 4-5 9 V C- 06-0t12
Check boxes below:
el Fill Excavation to grade
aK Sod or seed all bare soils
ta' Erosion control (see handout). Maintain erosion control until turf is established.
Er Cap sewer below grade.* Mark location. Licensed contractor required.
er Cap water below grade.* Mark location. Licensed contractor required.
V Cal1 City of Prior Lake Public Works Department (952.447.9898) for water meter
removal.
I Cap gas line.* (By gas company)
or' Disconnect electric at meter. (By electric company)
❑ Pump and fill cesspool /septic tank. Certified contractor required.
❑ Abandon well. Certified contractor required. Existing well
o'" Remove existing structure foundation and footings, materials, and debris.**
er Provide du • • of by following means:
. Water mist rom a water Suppl ii ie orp��
2. nc osure BUILDING PER IT LAN REVIEW
3. Other
INSPECTOR
Comments: (provide survey or draw sitD n) f 1g ft PErMIT NO.
❑ ACCEP ED S SUBMITTED
❑ ACCEPTED WITH CORRECTIONS AS NOT1
O NOT ACCEPTED- CORREC' x SE 'zt ►t3f,A1 "•
These comments are for your information A0 Way shalt be d(
in full compliance with aN applicable building & tonp„o code r
Tuir+emertts including Items not spec fk tty noted in this revif
KEEP TWS PtAAJ SET ON SITE AT At t T
*Capping of utilities must be inspected.
* * Final inspection and approval of restored site required. Deposit will be returned after
.o.proved final inspection.
Signature Date
J:IBUILDING\HANDOUTS\Demolition Restoration.doc
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