HomeMy WebLinkAboutDemo Permit 00-0840
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow . Appl~l
Perm~ No. 6 () . 6 '24-0
\
eCTIONS
1. DATE B.2- ~ .00
BUILDING INFORMATION
7. SIZE OF STRUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
8. NO. OF STORIES
2. SITE ADDR/ ~ 2. 7//
3. LEGAL DESCRIPTION
LOT _/2- BLOCK
ADDITION It I 11 V ES
F hn to r'f2 (11\ ri.. K 150
PID 2"5 - o:Yi - r. /3 - ()
/ fr LI'iKE Hl.-JLJN.
9. TYPE OF CONSTRUCTION
10. COMPLETION DATE
4. OWNER (Name)
(Address)
(leI. No.)
5. ARCHITECT (Name)
(Address)
(reI. No.)
, 6. CqlTRACTOR (~"{"e) JAddr.~ r:l ..\, , ,.., -? (rei, ~g.l. 35'-""
IS--t'V1,.-rr ~ Y'i:\.~~ :3~"l ~ ~ Vfr\Y\'~"''tfL~ ,Ih - Set:r ." r
I hereby certify I have furnished information which is to the be'st 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 ali 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.
7; ~ore, I t\A.rAb~~ city official or a design.'e may enter upon the property to perform needed inspections.
X~~W. ff-~~~~o
-- Sig sture Date
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METRO SAC UNIT DETERMINATION
i
FOR ADMINIISTRATIVE USE
7"'/ C ,K: E LJ (/ r-'
CJ:. ,# 'J"3 Z(cZ I
'725.00 fd-'
($e, 000. oc IN OIFE -
MATERIAL F~ED WITH APPLlCATIO .
'-.,.-'"
LJ Site Restoration Plan
LJ Utility Abandonment Plan
(] Sewer Abandonment
USE OF BUILDING
~r CJ
SITE RESTOR'" TION PLAN
LJ Water Abandonment
Accepted by
Rejected by
LJ Electrical Abandonment
LI Other
TYPE OF CONSTRUCTION:
II
III
IV
R
3
V
M
CREDITS
Park Oed. Cred~ ................................................ $
SAC Cred~ ......................................................... $
.'
Occupancy Group A
B
E
H
Division
2
4
Sewer & Water Co~nec. Fee Credit .................. $
Water Tower Fee Credit .................00..................$
Other ................00.0000........................................... $
TOTAL CREDITS ........................ $
,
,
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ThyapPlitJr. ;i.'c;pm your
dSmolitinh . m. whe approved ,A('
T"" . I ( , ... I~
By ) I, / Date I .., / rY~ Issued by '" Date
S,.N/V..'
f ) is to certity/that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
~ed ~J1equested. ,
/--~.J.~ h.-..- qllr:>/~.
- CitY Planner Date
Special Conditions if any