HomeMy WebLinkAboutDemo Permit #12-0132 ��� p R I �`�� � CITY OF PRIOR LAKE Date Rec' d
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- PERMIT NO. J� . C� /� -.
(Please e or rint and si at bottom)
ADDRESS . " ZONING(oft'ice use)
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LEGAL DESCRIPTION (office use only) .
LOT BLOCK ADDITI�N PID 'v..� .�'1�j �i � , �
OWNER -
(Name) G � �-��✓`e�t�p rh,o� �' (Phone)
(Address)
CONTRACTOR
(Company Name) �C.�''� �' � L_ L � (Phone) ���������D,�
(Contact Name) � �e-N S �.,.� (Phone)
(Address) f l � fv� (V 1 �/'`� _ �
Use of Bailding: INTBRNATIONAL BUII.,DIlVG CODE
Type of ConstrucCion: I II III IV V A B
Qccupancy Group: A B E F H I M R S U
Division• 1 2 3 4 5
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❑ MPCA NOTIFICATION O� INTENT TO PERFORM A DEMOLITION •
I hereby certify that I have furnished informarion on this application 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. T am aware that the building official can revoke this pemut for just cause. Furthermore,
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
� �IE,.T�O��1V�C�S�` S"��.�U�T'�. ����' � E � ��_' :
_ This lica n Becomes Your Demolitian �T� ;" ���A��p���� �:� �, `�; � �.�`• �'z � ; T �
it hen Appr�oved .
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This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested,
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Plannin uector Date Special Conditions, if any
2A hour notice for ail inspections (95�) 447-9850, fax (952) �47--t2�5
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
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;�� �-� ���� �' � Site Restoration Pro osal For Demolition
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Applicant: �- �-e+ C�3 LC� �
Address: _� /3�� gQ j-�p'� �ar�a G¢we
Check boxes below:
� Fill Excavation to grade
� Sod or seed all bare soils
� Erosion control (see handout). Maintain erosion control until turf is established.
❑ Cap sewer below grade.* Mark location. Licensed contractor required.
❑ Cap water below grade. * Mark location. Licensed contractor required.
❑ Call City of Prior Lake Public Works Department �952.447.9898) for water meter
removal. �
� Cap gas line.* (By gas company)
� Disconnect electric at meter. (By electric company) � .
� Pump and fill cesspool/septic tank. Certified contractor required.
� Abandon well. Certified contractor required. Existing well
� Remove existing structure foundation and footings, materials, and debris.* *
❑ Provide dust control by following means:
1. Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (p�ovide survey or draw site plan)
*Capping of utilities must be inspected.
.
�* Final inspection and approval of restored site required. Deposit will be retumed after
approved final inspection.
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Signature Date
J:4BUILDING�HANDOUTS�Demolition Restoration.doc