HomeMy WebLinkAboutDemo Permit 03-1333
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
Cf-15./0:3
1. White - File
2. Blue - City
3. Yellow - Applicant
DIRECTIONS
1. DATE
Permit No. 03.-1 /333
1 03 1~7S
BUILDING INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
9-/S>O 3
7. SIZE OF STRUCTURE
'c Q,.X If L
8. NO, OF STORIES
I
9. TYPE OF CONSTRUCTION
WOe d
10. COMPLETION DATE
O~ f:S
2. SITE ADDRESS C"
c'rJ9 :> /I(f)
3. LEGAL DESCRIPTION
LOT *
I pl<:6
rep
~vJ.
Zt:;-/?,3 -o7~-o
ADDITION
BLOCK 4-
p~ C(LCP rldN
pro
4. OWNER (Name)
Ph', If , JM~
5. ARCHITECT Name)
(J;,h.,
P..
Qos.3
6. CONTRACTOR (Name) (Address) ~ (Tel No.)
M 0'" ;-\- It. (~'" YO,) 0 e-Pl/I (f\J'r J'C (~L.. - ~ 5~ $) CS
I hereby certify I have furnished information which is to the best of my knowledge true and co ect. 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 property 0 perform needed inspections,
~ yY1'I ~
- r $'"1 () ~
x
Signature
Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
I
MATERIAL FI ED WITH APPLICATION
LJ Site Res ration Plan
~
C
-
USE OF BUILDING
S/ti-/0w MA1(i .t?WB.4~
SITE RESTORATION PLAN
Accepted by t/J If-
Rejected by
-
LJ Water Ab ndonment
LJ Other
TYPE OF CONSTRUCTION:
II
III
IV
V
CREDITS
Park Oed. Credit ................. .............................. $
SAC Credit .......................... .............................. $
Sewer & Water Connec. Fe Credit .................. $
Water Tower Fee Credit ..... ...............................$
Sso.r-
/275- -
12-~.. .-
iC(2 -
Division
H @ M
2 @) 4
Occupancy Group A
B E
By
Other ................................... .............................. $
TOTAL CRED S ........................ $ AD 1.5 .-
I
Date
Issued by
Date
This is to certify that the request in the above and accompanying documents is in accordance wit~ the City Zoning Ordinance and
m, proceed as r~*uest d. tt!(9 -
-'-~1 (~_ P 2~~ \ 0 :b.D::!:) II
t;JtI pfatner Date Special Conditions if any I
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
27
SP/24 III
OWNER
CONTR.
PHONE NO,
PERMIT NO.
[J FOOTING
[J FOUNDATION
[J FRAMING
o INSULATION
[J FINAL
[J SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
DATE
TIME if
L../f t::6
o EXlGRADIFILUN
o COMPLAINT
[J FIREPLACE RI
o FIREPLACE FIN
)6 GASLlNE A~ TS
i
I
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
[J CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: Owner/Contr:
CALL "7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE
,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFErt,
Il'tSNOTl