HomeMy WebLinkAboutDemo Permit 01-0737
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CITY OF PRIOR lAKE
DEMOLITION PERMIT
1. White
2. Blue
3. Yellow
- File
- City
. Applicant
Perm~ No. 6/-0737
DIRECTIONS
1. DATE & Ju In I
BUILDING INFORMATION
7. SIZE OF STRUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PER ~IT ISSUED
(Please print 0 type and sign at bottom).
8. NO. OF STORIES
2-
9. TYPE OF CONSTRUCTION
~D
10. COMPLETION DATE
2. SITE ADDRE is f +i->
(}()'f)7_ I SO SL <.[ Q <L nY- l.c, K.o
3. LEGAL OESC RIPTION
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ADDITION ~ fA ^ J..... , mu \',
4. OWNER (Na ne)
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5. ARCHITECT Name)
L.'t"'-~
(AddreSs)
/Jo'l'>7., \5~""h<;~.
(Address)
~r~c>'" Lc...lce
(leI. NO.)
q'S'2.. 44() -/SZ::
(Ter.No.)
6. CONTRACTC R (Name, (Address) /I I 0 1\-:---' (Ter. ~OI'A 1_ _ I ,. J 1 ?I.I 5~
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I hereby cer ify I have furnished information which is to the best of my Knowledge true and correct. I also certify that i am the
owner or aut 10rized agent for the above mentioned property and that all construction will conform to all existing state and local laws
and will pro! eed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furthermore, I herebga ee that t~~ic~r a designee may enter upon the property to perform leded inspections.
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- l SignatUre v ' I . 'bate
METRO SAC l NIT DETERMINATION
f
FOR ADMINISTRATIVE USE
-J."].O.. 01 ;t:.ed/O U:-4F~37qt!(, ~. ;)
A/ ~ NJ-1r ~ F ./I r; OOC. () 0 /'IV r~Fe
/ MATERfAL FILED WITH PLICATION
~ Site Restoration Plan
o Utility Abandonment Plan
LJ Sewer Abandonment
USE ?~':)
-
SITE RESTORATION PLAN
o Water Abandonment
Accepted by
Rejected by
LI Electrical Abandonment
o Other
TYPE OF CO~ STRUCTION:
II
III
H
2
IV
R
3
V
M
4
CREDITS
Park Oed. Cred~ ................................................ $
SAC Cred~ ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Occupancy Gn IUP A
B
E
Division
Water Tower Fee Cred~ .....................................$
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. quested.
~~~ 7,.,171DI
Date
Special Conditions if any