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<br /> YU� � NO PERMIT �� r 4�4i (
<br /> 4Building Permit -
<br /> " AND APPUCATION FOR CERTIFICATE OF OCCUPANCY DATE ISSUED Q" �^�� �
<br /> ;,:
<br /> �,:. EXPIRES
<br /> f P,O.:BOX 66,'CRYSTAL BAY, MN 55323 473-7357
<br /> SITE ADDRESS��,t�� ,';` �
<br /> �„ .ZONING DISTRICT` � s�-s-e —
<br /> � ;- • I.EGAL DESCRIPTION: PROP. ID. �,C,/7—�.� � _
<br /> � ��` � LOT BLOCK StJBDIVISION _
<br /> �FIRE ZONE
<br /> � ; WNER (Name) (Ad�ress) (Phone)
<br /> � ;,VAR.DATE G�.�e� "' ':'
<br /> ARCHITECT/ENGINEER—Must Certify Multi-Family,Commercial& Industrial Construction Plans
<br /> k` `COND. USE DATE ERT.NO. "�
<br /> (Firm) (Address) (Phone)
<br /> �, LOT AREA • ,;;
<br /> ;� .
<br /> ` WIDTH DEPTH BUILDER (Firm) (Address) (Phone)
<br /> �
<br /> PROPOSED SETBACKS`
<br /> ; "FRONT R.SIDE ": TYPE OF WORK New Additio Remodel Renova .
<br /> ...» ._ , •
<br /> � �REAR L.SIDE
<br /> tir.�s>��-: . . . . ,*,. _ � ,�:
<br /> ` CONST.TYPE BLDG.SIZE EST.CONST.VALUATION
<br /> � .�AKE,., WETLANDS �
<br /> E; "� �t� L. W. Ht. �1.Ar3��0
<br /> c7CiCiCJ
<br /> r A�E� RESIOENTIA STORIES B 1 z s PERMIT FEES
<br /> �'� �' - .:; ° ,� BLDG.PERMIT �j��
<br /> �` NEW' EXISTING DWELL. BDRMS/FLR s�
<br /> �AGE�ICY-APPROV.DATE uNirs STATE FEE
<br /> ''CITY r:, GAR.STALLS SEPTIC '
<br /> �,'a`� w.;. ATT. APP.DATE PLAN REVIEW �—
<br /> �COUNTY,, � + .; DEr. PENALTY -
<br /> t4�a��1.s,� +,•,.�
<br /> DOCK
<br /> �STATE'' +. NON•RESID. PROPOSED uSE PARK FEE
<br /> �;; � . - *!: . , ,
<br /> sPR.,EASEMENT oCC. SAC CHARGE
<br /> ;'-4,a, CLASS.
<br /> STORIES COUNCIL
<br /> �.;4t�. ��' APP.DATE TOTA� DUE Q�
<br /> K�REMARKS: '��e C�Q7��'��a�17ri.r dd,7.C.0 �1J�/L12[d� �� S S'� -
<br /> '��- .� - �.�ru.0 — �/1,�et� �l..,w•�c�7 � d� S St.�� s.
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<br /> ` ' sx�� ,�r1c� ���) �� . .
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<br /> � INSPECTION REQUIFiED WORK REQUIRING ACKNOWLEDGEMENT
<br /> SEPARATE PERMITS `,�
<br /> , ; =�•FOOTING before pour THE UNDERSIGNED HEREBY REQUBSTS PERMISSION TO MAKE
<br /> �.,_�FRAMING rough•in ,�
<br /> � < �_t0 INSULATION PLUMBING THE REAL IMPROVEMENTS SPEC�FIED, AND DECLARES '.i
<br /> h '�. WALLBCjARD Before Taping MECHANICAL UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT-
<br /> �
<br /> �' ' � WE�� ANCE OF ALL INFORMATION, CONDITIUNS AND REQUIRE- �
<br /> g, �FINALbefore occupancy SEPTIC
<br /> MENTS REPRESENTEO ON THIS DOCUMENT. T�iE UNDER—
<br /> Y '•WORK BEYON�OR WITHOUT A RE- SEWER �
<br /> r " SIGNED FURTHER AGREES T�DO ALL WORKS IN STRICT COM- ''�
<br /> QUIRED INSPECTION WILL BE SUB• yyATER +�,�
<br /> � �JEC'f l O PENALTY, GRADING&FILLING PLIANCE WITH ALL CITY OF OR;7N0 OfiDINANCES AND STATE .-
<br /> �`:, INSPECTION HOURS 473J357 OF MINNESOTA BUILOING CODE REdUIREMENTS. f�
<br /> CACL 8-12 A.M.INSP.1-4 P.M. ,*
<br /> ' '� CALL,1- 4 P.M.INSP.NEXT DAY ELECTRICAL from State ' J:�
<br /> X � �,/� . rf'7 g ;t
<br /> signacu.a�� oace �, �
<br /> yt�COPY:_' WHITE-FIL•E GREEN—FINANCE �%
<br /> �' �
<br /> �.CANARY-INSPECTOR ' GOID—FiECEIPT �+'!!
<br /> `�e`xk`�� ;PINK ASSESaOR ;_ Approved City of Orono �
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