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CITY of olt()NO <br />Building Permit PERMIT NO. 5850, <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE ISSUED <br />P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br />ZON DISTRICT <br />FIRE EPARTMENT <br />Z723Q La <br />POST OFFICE <br />VAR.DATE _ <br />COND USE DATE <br />LOT AREA <br />WIDTH ADEPT <br />PROPOSED SETBACKS: <br />FRON IR SIDE <br />REAR I SIDE <br />LAKE WETLANDS <br />ACCESS <br />NE EXISTING <br />A APPROV DATE <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />REMARKS <br />SITE ADDRESS __9 ` , $ o " OLioc "r\_ ( l�lV SZ <br />PROPERTY IDENTIFICATION NO IPIDI A=1 I 1` �� !�i cis oo <br />LOT BLOCK _ SUBDIVISION <br />OWNER (Name) (Address) (Phone) <br />ARCHITECT/ENGINEER - Must Certify Multi -Family Commercial 8 Industrial Construction Plans <br />(Firm) (Address) (Phone) <br />BUILDER (Firm) <br />tAddress) <br />Phone) <br />e7O �a(o <o <br />DI(Wi 1 rt l <br />I <br />TYPE OF WORK ew Addition <br />Remodel <br />Re ovate <br />S <br />CONST TYPE <br />BUILDING SIZE <br />Estimated Construction Valuation <br />W q0 <br />tt <br />Ht� <br />OCCUPANCY <br />PE <br />MIT FEES <br />CLASSIFICATION <br />BLDG. PERMIT <br />\� S- <br />DWELL <br />STORIES B 1 3 <br />UNITS <br />STATE FEE <br />PLAN REVIEW <br />GAR STALLS <br />ATT ✓ <br />NUMBER OF DROOMS <br />DET <br />SEPTIC <br />APP DATE <br />SAC CHARGErJ'.�L1� <br />SEWER UNIT <br />_ <br />PROPOSED USE <br />PARK FEE <br />PENALTY <br />COUNCIL <br />APP DATE <br />OTHER <br />TOTAL DUE <br />/ 47, / <br />INSPECTION REQUIRED <br />WORK REQUIRING <br />SEPARATE PERMITS <br />.... FOOTING before Dour <br />.... FRAMING rough -in <br />PLUMBING <br />.... INSULATION <br />MECHANICAL <br />. .. WALLBOARD before taping <br />.... FINAL before occupancy <br />WELL <br />...... SITE INSPECTION <br />SEPTIC <br />WORK BEYOND OR WITHOUT A RE- <br />SEWER <br />❑ <br />QUIRED INSPECTION WILL BE SUP <br />❑ <br />JECT TO PENALTY <br />WATER <br />"""' <br />GRADING 8 FILLING <br />❑ <br />INSPECTIONS MUST BE CALLED -IN <br />24 HOUrS IN ADVANCE <br />FIRE <br />LJ <br />COPY WHITE -FILE GREEN FINANCE <br />CANARY -INSPECTOR GOLD RECEIPT <br />PINK -ASSESSOR <br />McMlrn htt • •OY Cc Iw fef 2f Slf w?0 <br />ACKNOWLEDGEMENT <br />THE UNDERSIGNED HEREBY REUUESTS 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 />pUANCE WITH ALL CTY OF ORONO ORDINANCES AND STATE <br />OF MINNESOTA BUILDING CODE REOUIREMENTS <br />Slgna:ure Dare,, <br />i <br />L _ <br />