HomeMy WebLinkAboutDemolition 03-0726
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
Permit No. 03-072-&
DIRECTIONS
1. DATE
BUILDING INFORMATION
7. SIZE OF STRUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
8. NO. OF STORIES
2. SITE ADDRESS 17 Z I ro
3. LEGAL DESCRIPTION
1<.6V6RE
t1fA
9. TYPE OF CONSTRUCTION
LOT
BLOCK
PID 25-Cl/Z- 001-0
10. COMPLETION DATE
ADDITION
'II-, S/:;_
METRO SAC UNIT DETERMINATION
MATERIAL FILED WITH APPLICATION
o Site Restoration Plan
o Utility Abandonment Plan
CJ Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
CJ Water Abandonment
Accepted by
Rejected by
CJ Electrical Abandonment
CJ Other
TYPE OF CONSTRUCTION: " III IV V
Occupancy Group A B E H R M
Division 2 3 4
.... 6/A
By Date
CREDITS
Park Oed. Credit ................................................ $ ~
SAC Credit ......................................................... $ ~
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
$1.
Other .................................................................. $ .
TOTAL CREDITS ........................ $
Issued by Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
max pro eed_as r qu ted. / _
. \ 0-,0. O'
Date
Special Conditions if any