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CITY of ORONO <br /> Building Permit PERMIT NO. 5g3 1 � <br /> AND APPLICATION FOR CERTiFICATE OF OCCUPANCY DATE ISSUED t�' � r U� <br /> P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br /> ZONING DISTRICT <br /> SITE ADDRESS <br /> PROPERTY IDENTIFICATION NO.(PID) — � ' L <br /> FIRE DEPARTMENT LOT BLOCK SUBDIVISION <br /> POST OFFICE OWNER (N�me) (Address) (Phone) <br /> � ' � <br /> VAR. DATE ARCHITECT/ENGINEER- Must Certify Multi-Family,Commercial& Industrial Construction Plans <br /> (Firm) (Address) (Phone) <br /> COND. USE DATE <br /> LOT AREA BUILDER (Firm) (Address) (Phone) <br /> WIDTH TH ` � ` <br /> TYPE OF WORK New Addition Remo el Renovate <br /> PROPOSED SE S: ��� <br /> FRONT R SID <br /> CONST.TYPE BUILDING SIZE E�ated Construction Valuation <br /> REAR L. DE <br /> IAKE WETLANDS L. W. Ht. / �O1,1 <br /> OCCUPANCY PERMIT FEES <br /> CLASSIFICATION !� �C� <br /> ACCES DWELL. STORIES g � 2 3 BLDG. PERMIT V � <br /> UNITS s � <br /> NE T G STATE FEE <br /> AGENC R . ATE GAR.STALLS NUMBER OF BEDROOMS <br /> ATT. PLAN REVIEW <br /> CITY DET. SEPTIC <br /> APP. DATE SAC CHARGE <br /> COUNTY PROPOSED USE SEWER UNIT <br /> STATE PARK FEE <br /> PENALTY ��� �O <br /> PRIVATE EASEMENT COUNCIL <br /> APP. DATE OTHER <br /> TOTAL DUE c�j4 <br /> REMARKS: � � � ► <br /> � <br /> WORK REQUIRING ACKNOWLEDGEMENT <br /> INSPECTION REQUIRED SEPARATE PERMITS <br /> ❑ .. ... . FOOTING before pour THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br /> ❑ . . .. . . FRAMING rough-in PLUMBING ......................... ❑ THE REAL IMPROVEMENTS SPECIFIED. AND DECLARES <br /> ❑ . . ... . INSULATION MECHANICAL....................... ❑ UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> ❑ WALLBOARD before taping ANCE OF ALL INFORMATION, CONDITIONS AND REQUIRE- <br /> . FtNAL before occupancy <br /> WELL............................ ❑ <br /> . ... . <br /> . ... . . SITE INSPECTION SEPTIC.............................. � MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER- <br /> WORK BEYOND OR WITHOUT A RE- SEWER.............................. � SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM- <br /> QUIRED INSPECTION WILL BE SUB- PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br /> JECT TO PENALTY. WATER............................ . ❑ <br /> GRADING&FILLING ............... ❑ <br /> OF MINNESOTA BUILDING CODE REQUIREMENTS. <br /> INSPECTIONS MUST BE CALLED-IN <br /> 24 HOURS IN ADVANCE. FIRE................................. ❑ �, � ,,r� <br /> Signature CR Date�/—�� <br /> COPY:WHITE-FILE GREEN-FINANCE _ <br /> CANARY-INSPECTOR GOLD-RECEIPT <br /> PINK-ASSESSOR Approved City of Orono <br /> Brooklyn Prtg.&Adv.Co.Inc. (612)567�470 <br />