HomeMy WebLinkAboutDemolition Permit
CITY OF PRIOR LAKE
C I TV'S CO pyoUTION PERMIT
6-15~O~
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1. While - File
2. Blue - City
3. Yellow - Applicant
Permit No. 03 - O~
DIRECTIONS
1. DATE f)-I f)- 3
LOT
BLOCK
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A25i36.~'-f2~
BUILDING INFORMATION
7. SIZE OF STRUCTURE
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8. NO. OF STORIES
C>N&
9. TYPE OF CONSTRUCTION
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10. COMPLETION DATE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
2. SITE ADDRESS
15~61 -( t:'o//lJT I<n. s,E,
3. LEGAL DESCRIPTION
PID
b - (5 - t>3
ADDITION
MA \) &S
4. OWNER (Name)
;)bHAJ S. 1I7'l-t.'s
5. ARCHITECT (Name)
(Address) (Tel. No.)
5'"33 I FAbST"" f>(>I/-Jr fA I &t 1-AKt:, h-uJ ~t;;,e- I:fLf(,15 -S-~ / ~
(Address) (Tel. No.)
S,A,H E
6. CONTRACTOR (Name)
(Address)
(Tel. No.)
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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.
Furthermo I he[ by a ee th t the city oJflcial ~! a designee may enter upon the property to perform needed inspections.
f)'-/ ~-tJ5g
Date
v
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
MATERIAL FILED WITH APPLICATION
o Site Restoration Plan
o Utility Abandonment Plan
o Sewer Abandonment
USE OF BUILDING
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SITE RESTORATION PLAN
o Water Abandonment
Occupancy Group A
B
E
Accepted by
Rejected by
II III IV (9
H ~ M
2 4
o Electrical Abandonment
o Other
This application becomes your
rJemolition permit when approved--
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Date O,,@ 7~ :1
,
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other.. ......... ..... ............................... ..... .............. $
TOTAL CREDITS ........................ $
Issuedby ~ ~ Date $'P?~..7
TYPE OF CONSTRUCTION:
Division
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed as requested.
City Planner
Date
4~.
Special C n Ilions i any
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