HomeMy WebLinkAbout96-008of PRlok CITY OF PRIOR LAKE 1, wham - File
DEMOLITION PERMIT 2. Blue - City
3, yNbx - APWwenl
' Permit No.
DIRECTIONS -
1,. DATE j i g
BUILDING INFORMATION
SPACES NUMBERED I THRU 10 MUST BE FILLED IN
7. SIZE OF STRUCTURE
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BEFORE PERMIT ISSUED
(Please print or type and sign at bottom). /1 5 ,. 1
a. NO. OF STORIES
A ire
27REA RESS -
9. PEOF CONSTRUCTION
IAIA 11
3. LEGAL DESCRIP,jlptj 1 '��/ 1a. COMPLETION DATE
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L0,/ BLOCK PID
ADDITION L a�p Q, > f AX
a.OWNER (Name) (Address) (Tel. NO)
S. ARCHITECT (Name) (Address) ( Tel. No.)
S. CONTRACTOR (Name) -.. (Address) -. (Tel. NO)
I Hereby certify -L have furnished information which is to the best of my knowledge true and correct. 1 also certify that Iam the
owner orauthon2ed agent for the above mentioned property and that all construction will conform to all 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. agree that tthhe city official or a designee may enter upon) the property to perform needed. inspections. -
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Signature s. Date.
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION �=� 2 S� MATERIAL FILED WITH APPLICATION
O Site Restoration Plar Loa,
I
_
O Utility Abandonment Plal�10
O Sower Abandonment
us F F BUILDI ! Gam_ SITE RESTORATION PLAN.. O Water Abandonment
Accepted by 1`1 O Electrical Abandonment
Rejected by - —�� Cl Other
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CREDITS
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TYPE OF CONSTRUCTION: I : It III IV C Park. Dad. Credit ................................................ $ n
TYPE
$ rp.
T
H t SAC Credit .........................................................
' M
Occupancy Group A B E.
'"� Sewer S Water Connect Fee Oredn.. •. $
1
Division 4. 2.. 4' Water Tower. Fee Credit ......: -. .......$
Other ........: - ......... ............ $ m.
Thisapplica becomes your TOTAL CREDITS .......::........$
demolition a(mkwlum approved ^)^'
Date
By Data / \ ��� (._ lesued by
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance . and
m des recfki
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City Planner Data Special Conditions if any
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