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A M 01 <br />Building Permit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66. CRYSTAL BAY. MN 55323 473-7357 <br />PERMIT NO. 5636 <br />DATE ISSUED <br />ZONING DISTRICT <br />FIRE DEPARTMENT <br />POST OFFICE <br />VAR. DATE <br />LAKE ETLANDS <br />ACCESS <br />NEW EXISTING <br />AGENCY-APPROV. DATE <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />SITE ADDRES.S_______________________________________ ___ <br />PROPERTY IDENTIFICATION NO. (Pint <br />LOT^----------------------_BLOCK_-----------------------------SUBDIVISION <br />OWlJ£R (Address) y <br />' ' T/.(Firm) <br />BUILDER <br />_ __________________________________' i r c/ l-T <br />- Must Certify Multi-Family. Commercial & Industrial Construction Plan, <br />(Address) (Phone) <br />(Firm)(Address)(hiione) <br />TYPE OF WORK <br />CONST. TYPE <br />Addition Remodel Renovate <br />BUILDING SIZE <br />L. W.Ht. <br />OCCUPANCY <br />CLASSIFICATION <br />DWELL. <br />UNITS <br />GAR. STALLS <br />ATT. <br />DET. <br />STORIES B <br />NUMBER OF BEDROOMS <br />E^mated Construction Valuation‘I <br />SEPTIC <br />APP. DATE <br />PROPOSED USE <br />COUNCIL <br />AFP. DATE <br />:^j6aeA- <br />blog PERMIT <br />S’ATE FEE <br />PLAN REVir V <br />SAC CHARGE <br />SEWER UNIT <br />PARK FEE <br />PENALTY <br />OTHER <br />PERMIT FEES <br />rSO <br />TOTAL DUE <br />INSPECTION REQUinEO <br />O............FOOTING before pour <br />•♦•••• FRAMING rouph*in <br />□ ........INSULATION <br />.........WALLBOARO before taping <br />..........FINAL before occupanc\> <br />□ ........SITF INSPECTION <br />WORK BEYOND OR WITHOUT A RE­ <br />QUIRED INSPECTION WILL BE SUB­ <br />JECT TO PENALTY. <br />INSPECTIONS MUST BE CALLED-IN <br />24 HOURS IN ADVANCE. <br />WORK REQUIRING <br />SEPARATE PERMITS <br />PLUMBING...................................□ <br />MECHANICAL................................CH <br />WELL...........................................D <br />SEPTIC............ D <br />SEWER..........................................D <br />WATER..........................................CU <br />GRADING & FILLING.....................C <br />FIRE..............................................□ <br />COPY; WHITE-FILE <br />CANARY-INSPECTOR <br />PINK-ASSESSOR <br />iroskhfw ^0. ft Co. NIC fftlT) mi-4470 <br />ACKNOWLEDGEMENT <br />THE undersigned HEREBY BEQUESTS PERMISSION TO MAKE <br />THE REAL IMPROVEMENTS SPECIFIED. AND DECLARES <br />UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT­ <br />ANCE OF ALL INFORMATION CONDITIONS AND REQUIRE­ <br />MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER­ <br />SIGNED further AGREES TO DO ALL WORK IN STRICT COM­ <br />PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br />OF MINNESOTA BU><lNG CODE REQUIREMENTS. <br />GREEN-FINANCE <br />GOLD-RECEIPT <br />Signnturi <br />Approved <br />Date <br />tv of Orono