HomeMy WebLinkAboutDemo Permit 03-0914
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. While
2, Blue
3. Yellow
- File
- City
- Applicant
Perm~ No. 03 -oQ/4-
DIRECTIONS
1. DATE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or typa and sign at bottom).
/0. /5. IJ;3
BUILDING INFORMATION
7, SIZE OF STRUCTURE
3-::>..c~
8. NO. OF STORIES
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9. TYPE Of CONSTRUCTION
V-A
'0, COMPLETION DATE
2. srTE ADDRI::SS
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LOT
~LOCK
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PID 2S. 00/. (J5(P. 0
3. LEGAL DESCRIPTION
ADDITION
4. OWNER (Name) vJ~
5. ARCHrTECT (Nama)
I I (Address)
/"'bt'\ ~
(Address)
/BQS PlalfL [)nve.. #:zEjNo.) (rtSJ-4t/r;-l/L./tfJ
(roL No,)
6. CONTRACTOR(Namal.~,_, . A .- _ V (Add'o"" v-.../" ~ _L' rroI.NOh5,r) -<6'(J"-3"/V'I
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I hereby certify I have furnished informatibn which is to the best of my knotAedge 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 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 the P7:erty to perform needed inspections.
x l/hy JJ, L-. Y11,A) Jt)LI'i ~ ~ a S"M:.IJ . .p Jt) 1:; If) '3
a Signature -- J . I . Date
METRO SAC UNIT DETERMINATION
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FOR ADMINISTRATIVE USE
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'5;POO.O(/ (N V,-</V"? r- ~
MATERIAL FILED WITH APPLICATION
o Site Restoration Plan
o Udlity Abandonment Plan
o Sewer Abandonment
USE OF BUILDING
5/~ fA"re..r
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SITE RESTORA~lN
Accepted by
Rejected by
0, Water Abandonment
o Electrical Abandonmant
o Other
TYPE OF CONSTRUCTION:
\I
1\1 IV (J)
H @ M
2 & 4
CREDITS
Park Oed. Cred~ .........................l~................ $ ~-:)o
SAC Cred~ .....................................l.e............... $ I 'Z is. -
Sewer & Water Connec. Fee Cred~ .../.6(......... $ 1 -z..CO. -
Water Tower Fee Credtt ............,~.................$ 100,-
Other .................................................................. $
TOTAL CREDITS ........................ $ f:'zs. od
Occupancy Group A
B E
Division
By
~.~"
Issued b"
Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m~ proceed as req sted.
Cl,10.re
Date
Spacial Conditions if any
DATE TIllIE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
4~Ca Co DAt::.o11't- )'f":'
OWNER
CONTR.
PHONE NO.
(j ~ _ Cf1/ +'
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
OWner/Contr:
CALL ....7-8860 FOR THE NEXT INSPECTlON:U HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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