HomeMy WebLinkAboutDemo Permit 00-0883
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
7. 20.00
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C1W OF PRIOR LAKE
I i~, ':MOLlTION PERMIT
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DIRECTIONS
1. DATE
8. NO. OF STORIES
2. SIIE ADDRESS 4'-9#1 f? ~erlS'fiNl
.3. LEGAL DESCRIPTION L' .
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LOT L-L9 0 BLOCK \0
54
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9. TYPE OF CONSTRUCTION
, O. COMPLETION DATE
ADDITION
weSt
PID_2S-005- 003- 0
sloe ~ON.
4. OWNER (Name)
(AddreSS)
(ieI.No.)
5. ARCHITECT (Name)
(Address)
(Tel. No.)
6. CONTRACTOR (Name)
(Address)
(Tel. No.)
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
and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furlherm~} 2r"eby aj1~e. hat.ll'le city ollicial or a designee may enter upon the property to perform needed inspections.
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FOR ADMINISTRATIVE USE
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MATERIAL FILED WITH APPLICATION
METRO SAC UNIT DETERMINATION
CJ Site Restoration Plan
IJ Utility Abandonment Plan
CJ Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
o Water Abandonment
Accepted by
Rejected by
o Electrical Abandonment
IJ Other
City Planner
CREDITS
Park Oed. Credit ................................................ $
SAC Cred~ ......................................................... $
Sewer & Water Connec. Fee Cred~ .................. $
Water Tower Fee Credit .....................................$
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~ >- re~qt in the above and accompanying documents ~ccordance with the City Zoning Ordinance and
d. lOr 2./ cV
Date SpeCial Conditions it any
II
III
IV
V
TYPE OF CONSTRUCTION:
Occupancy Group
A
B
E
H
R
M
Division
2
3
4
By
m
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