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� �:; �,, 5� {1() :�i����i . <br /> t� <br /> CITY O�' O�ONO APPLIt;AT�ON FO�R DEMOLITION Y�RMIT <br /> P.O. Box-�6(2750 Kelley Pazkway) <br /> Crys�at Bay,N�N 55323 <br /> SPECIAL CONAITI4NS &HOLD 13ARMLESS AGkEEMEN? <br /> GeneralInstructions � <br /> 1, You may be required to obtain other permits, i.e.well abandonmment, etc. <br /> 2, Work must not begin unless the pennit cazd is available on the job site. <br /> 3. A 24 hour notice is required for all insF►ec�ions. CaJ.I(612)249�4b00. <br /> JOB SITE A:DDRESS: �° b 4 s116_,�.,i�� �l I�cl O r a-, � <br /> Occupancy Type: X_Residontial C�mmercial ( /�` <br /> /1w 1 ,�/14AfIlC/\�N �, �,�� �/� - �V-7 i• <br /> �Nt ]F rltTil�� r Phone: 9$;�- �i�i- �ss - <br /> OWN�R'SNAME� � �� I�I;,,� _ � „� Ssyo, <br /> Mailing Address: ��b u �-. � �U_ _City: 9��.�� _ <br /> ^ Bus.No.; �7c�3 - y�. - »U.� <br /> CONT�tACTOR'S NAME: ��;� -1- L,,..��,s.-r -�-^� <br /> --'"� _czry:�.�,u, . ��3 'y <br /> Mailing Address: /y��:. �:� �k� <br /> �aso.- /`'lu�l(� <br /> Demolition if plaxu►ed by means of: �,,.,manual disass�mbly <br /> �heavy equipmen� <br /> Permits Zssued: <br /> #�,Well Abandozument , <br /> In zetwrn for issuance of said Demolition Pemut,the:undersignecl ownez hereby agrees as follows: <br /> 1, The structure(s) shall be kept enclosed ancUdr secured until such time as demolition is <br /> complete. <br /> ? Demolition debris will be kept off adjoining property and�'or the public rights-of-way uuless <br /> specific prior approval is obtained in writii�g for tempor2u�y use thereof. , <br /> 3, Foundations shall be completely removed fi•om the giou�d. _ <br /> 4. All demolxtion debris shall be co�►pletely disposed a£ off site in accordance with all <br /> applicable PCA requizements. <br /> 5. Water�vells must be abandoncd in.accordauice with State Health Department regulations. <br /> b. Inspection requir�d when all debris has been remo�ed, t>efore backfilling. <br /> �---__.__._------. <br /> _-�-----.._. � <br /> _ � <br /> 5D5-� ll0/ll0 r� ZE9-1� 9�9Y8qZZ56+ ONOaO f0 �lll�-wo�� wpq(:jp t00Z-OZ-�^d <br /> £ d i85G509Z 'ON/L �8 '.LS/8i � ti0 ,OZ '8 (NOI�I) '�I�[I hAlddl^i0� 'i8 .LI�A Y�IOZi3 <br />