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C�TY Ol ����1�'�� PERMIT Iv�) V 5205 I <br /> Building Permit oATE �SS�Eo Z_��:_�� <br /> AND APPLICATION FOR CERTIFICATE OF OCCUPANCY EXPIRES <br /> P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 �Lf� �j'rA�e.c_7S �� ��C� <br /> ZONING DISTRICT SIT� ADDRESS ` ,-n.✓ <br /> LEGAL DESCRIPTION: PROP. ID. I I � I 7 Z� �� �'C-�'� <br /> LOT BLOCK SUBDI VISION <br /> FIRE ZONE <br /> WNER (Name) (Address) (Phone) <br /> VAR. DATE Lt'� �'Cs���: k _ SC-C� _Kl- c. <br /> ARCHITECT/ENGINEER — Must Certify Multi-Family, Commercial & Industrial Construction Plans <br /> COND. USE DATE ERT.NO. <br /> (Firm) (Address) (Phone) <br /> LOT AREA <br /> WIDTH DEPTH BUILDER (Firm) (Address) (Phone) ��Z <br /> p-�7 2.�7 <br /> PROPOSED SETBACKS �� � S � � / / / L � '� � <br /> �.._::._ � <br /> FRONT R.SIDE TYPE OF WORK New Addition Remodel Renov�te'-�, <br /> R E A R L.S I D E �c.w..�Lti;� L.l.:l�L L r �" S i A L_L �(.,-lei�. //l,'i�l</�'�� <br /> CONST. TYPE BLDG. SIZE EST.CONST. VALUATION <br /> LAKE WETLANDS <br /> L. W. Ht Gr'�'�r <br /> ACCESS RESIDENTIA STORIES B 1 2 3 PERMIT FEES <br /> BLDG. PERMIT ��'•c�(� <br /> NEW EXISTING DWELL. BDRMS/FLR - '� <br /> AGENCY-APPROV. DATE utvlTs STATE FEE S � <br /> CITY GAR.STALLS SEPTIC PLAN REVIEW <br /> ATT. APP. DATE <br /> COUNTY oET. PENALTY <br /> DOCK <br /> STATE <br /> NON-RESID. PROPOSED USE PARK FEE <br /> PR. EASEMENT oCC. SAC CHARGE <br /> C LASS. <br /> STORIES COUNCIL ^� �� / <br /> APP. DATE TOTAL DUE G--G. <br /> REMARKS: U`t.l�� ��. 1�.ti�'� �;r�,� -1 �' , �,\��C 1!`-\i _j� /1� ���,� �FD � <br /> I�C: '� ��-�,/' ►\��i�al_ �Cf�o��5 <br /> —T <br /> INSPECTION REQUIRED WORK REQUIRING ACKNnWLEDGEMENT <br /> FOOTING before pour SEPARATE PERMITS <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br /> FRAMING rough-in <br /> INSULATION PLUMBING THE REAL IMPROVEMENTS SPECIFIED, AND DECLARES <br /> WALLBOARD Before Taping MECHANICAL UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> WELL ANCE OF ALL INFORMATION, CONDITIONS AND REQUIRE- <br /> _FINAL before occupancy --— <br /> SEPTIC -- MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER— <br /> WORK BEYOND OR WITHOUT A RE- SEWER <br /> QUIRED INSPECTION WILL BE SUB- SIGNED FURTHER AGREES TO DO ALL WORKS IN STRICT COM- <br /> WATER <br /> JECT TO PENALTY, PLIANCE WITH ALL CITY OF OR O ORDINANCES AND STATE <br /> GRADING&FILLING <br /> INSPECTION HOURS 473-7357 OF MINNESOT �UILDIN COD f EQ REMENTS. <br /> CALL 8 - 12 A.M. INSP. 1 -4 P.M. <br /> CALL 1 - 4 P.M. INSP. NEXT DAY ELECTRICAL trom State �� <br /> Signatur ate <br /> COPY: WHITE—FILE GREEN—FINANCE - <br /> CANARY—INSPECTOR GOLD—RECEIPT • <br /> PINK—ASSESSOR Approved � � �'l� '' --+''- City of Orono <br />