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� <br /> O,� ['OR CITY USE ONLY <br /> i 0¢ ��� '��' � � Date Received: !�� Permit# �( �: �C!(i `�� <br /> �.��.� ', � <br /> �y, �1�� �� � \ � Amount: $�'� SAC Credit: C a <br /> �'r� <br /> �'< ��,rJ,!�J� I v .�X. <br /> �ESK�P Homeowner(s)Signed: ❑Yes / <br /> �C� Resolutions(if any)Signed:Q✓ Yes ❑None Required <br /> Zonin Disdosure Si ed: ❑Yes ❑None Re uired <br /> �,i 1�Y OF �RONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or 7_oning Department) <br /> 7ob Site/ Owner Infornlation: <br /> Type: [� Residential ❑ Coimnercial <br /> Site Address: JZ`)� CA�'m c��,' /Z,�) <br /> Owner: � ���+'� �-[� i.�•� C Mailing Address: <br /> City: Zip: <br /> Home Phone: Alteniaie Phone: <br /> Contractor/Applicant Infonnation: <br /> Contractor/App.: �t;n,�=2i Lt�Ai�„ ��-am�_� ContactPerson: '��� <br /> Address: `� t�5 1�1� W�0�S ���—V D State License#: ��`�� <br /> City: �-j�'��t^hi�'1�N Zip: �'�'� � Expiration Date: -������ �] <br /> Phone: ��S� -�I�v-� (✓(� s t'i Alternate Phone: ��!Z- (ov o � 7�� 3 <br /> ` SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT � <br /> General Instnlctioils: <br /> 1. You may be required to obtain other permits, i.e.: well abandoliment, sewer, etc. <br /> 2. Worlc must not begin unless the pennit card is available on the job site. <br /> 3.._, A 24-4811our notice is required for all inspections. Call (952) 249-4600. <br /> }� 4. �'Sewer must be discontinued at the City service by qualified contractor before demo pez-cnit is <br /> � ;� issued. <br /> P�•`�� �( \�� �� � <br /> � � ,n0�,`'\�'k�\. <br /> �`b � 'fleniblitioil by means of: ❑ Manual Disassernbly � Heavy Equipment ❑ Other <br /> \ <br /> Permit(s) Issued: ❑ Sewer Disconnection ❑ Well Abandorunent # <br /> In retunl for issuance of said Denlolition Pe�nlit, the undersigned owner hereby a,�rees as follows: <br /> i. The struciure(s) shall be kept enclosed andior secured until such time as demoliiiori is <br /> complete. <br />