HomeMy WebLinkAboutDemo Permit 04-0668
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
,. White
2. Blue
3. Yellow
File
City
Applicant
Permit No, 0 otf . (J c,,, e
DIRECTIONS
1, DATE
I..j- 7- 0,/
BUILDING INFORMATION
7, SIZE OF STRUCTURE
750 -S61 n-
8. NO, OF STORIES
I
9, TYPE OF >,ONSTRUCTlON
..5f,'t1
10, COMPLETION DATE
SPACES NUIIBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PEl MIT ISSUED
(Please print ( r type and sign at bottom).
2. SITE AOOR! 55
4:l)O Gr...:,.
3. LEGAL DES ;RIPTION
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ADDITION
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4. O~ER (N, me) ,
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5. ARCHTrECl (Name) -r\
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6. CONTRACT)R (Name) .
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(AddreSs)
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(Address)
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(Tel. No.)........ ./
(Address)
(Tel. No.)
I hereby ce lify I have furnished information which is to the best of my knowledge true and correct. I also certify that I am the
owne' or au,lhorized agent for the above mentioned property and that all const,uction will conform to all existing state and local laws
and will pro oeed in acco,dance with submitted plans, I am aware that the building official can revoke this permit for just cause,
Furthermor;, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections,
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Signature
Date
METRO SAC JNIT DETERMINATION
FOR ADMINISTRATIVE USE
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(IN .f'-"irC;;
MATERIAL FILED WITH APPUCA TION
o Site Restoration Plan
o Utility Abandonment Plan
(j Sewer Abandonment
USE OF BUlL )ING
S,F;If) ,
SITE RESTORATION PLAN
o Water Abandonment
Occupancy G oup A
B
E
Accepted by
Rejected by
II III IV 0
H @ M
2 6) 4
Ij Electrical Abandonment
Ij Other
Division
CREDITS
Park Oed, Credit ",0.""0.0.0.0."'0.0.0.0.,,0.0.0.,0.0.0.0.0., $
SAC Credit ""0..0..0.0..0..0.0..0.0.0.,,,,,,,,,.,,,,,,,,,,,,0.,,,, $
Sewer & Water Connec, Fee Credit """,,,,,,,,,,., $
Water Tower Fee Credit """""""."",,,,,,,,,,,,,,,,,,$
Other """''''''',,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.,,,, $
TOTAL CREDITS "'''''''''''''''''''''' $
TYPE OF CO ~STRUCTION:
This applicatic In becomes your
demolition pe mit when approved
BY~~~
Date ",/, 7/0 '-/
,
Issued by
Date
This is to CE rtily that the ,equest in the above and accompanying documents is in accordance with the City Zoning O,dinance and
maytIocee d as r~ues\9J' ..
IN.l-o {fl... ~ 1/\ 1-"(D' JtetJlf
City anr sr Special Conditions if any
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