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('9ITS'4)f OR NO PERMIT ! 50791 <br />Building Permit <br />DATE ISSUED 7 �' J <br />AND APPLICATION FOR CEPTIFICATE OF OCCUPANCY EXPIRES <br />P.O. BOX 66, CRYSI , ,L BAY, MN 55323 473 7357 ` <br />ZONING DISTRICT SITE ADDRESS . _. �_LIe .L' �!Id a i. i` A — <br />LEGAL DESCRIPTION PROP. ID. L .lL_ <br />---- ------ IOT RLOCK SURDIVISION <br />FIRE ZONE <br />VAR DATE <br />COND USE DATE <br />LOT AREA <br />WIDTH <br />DEPTH <br />PROPOSED SETBACKS <br />FRONT <br />R.SIDE <br />REAR <br />L SIDE <br />LAKE <br />WETLANDS <br />ACCESS <br />NEW EXISTING <br />AGENCY APPROV DATE <br />CITY - <br />COUNTY — <br />STATE <br />PR. EASEMENT <br />REMARKS <br />INSPECTION REQUIRED <br />I :_)v T 0. - <br />FRAMIh <br />INSULATION <br />WALLBOARD EIr• ,• n <br />F INA L haiom ou. uparx y <br />WORK BE VONO OR WITHOUT A H1 <br />QUIRED INSPECTION WILL BF SUN <br />J1CT TO PENAL TV <br />INSPlr TION HOURS E13 1,1'+I <br />CAL L8 12AM INSP 1 4P%4 <br />CA(L 1 4 PM INSP NETT IIAV <br />F <br />INdrne) (Address) (Phone) <br />ENGINEER Must Certify Mult, Family, Commercial & Industrial Consfruct)on Plans <br />Firm) IAddressl - (Phones <br />BUILDER IFrTm) <br />TYPE OF WORK New <br />IM"T T,Pt Hi III, 91/1 <br />i <br />ITWI LI HORMS F L R <br />( .,i, srnLL>, StP, <br />API' LIAT1 <br />LASS <br />IES ("(YJ%( IL <br />APP 1.a1I <br />WORK REQUIRING <br />SEPARATE PERMITS <br />PLUMSINU _ <br />MECHANICAL <br />WELL <br />SE PT IC SEWER <br />WATER <br />GRAOIN(, & H u. 1 1'0. <br />FLFrTRICAL 1,on, STn'r <br />COPY WHOF f II 1 . . I - '`A rV(F <br />CANARY INSPF( To" GOL.0 RtC1tPT <br />PINK ASSFSSOH <br />(Address) (Phor- <br />Addition <br />�irlil� <br />�em(niel Renovate <br />1`,T I: ST VAI IJATIO'. <br />PERMIT FEES <br />HLOG PERMIT 3�{ S �` <br />STATE FEE <br />PLAN REVIEW <br />PENALTY <br />PARK FEE — <br />SAC CHARGE <br />TOTAL DUE j c� <br />ACKNOWLEDGEMENT <br />THE UNOERSI(;NECT HEFIEfir REQUESTS PERMISSION TO MAKE <br />THE REAL IMPROVEMENTS SPECIFIED AND DECLARE$ <br />UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT <br />ANCE OF ALI INFORMATION CONDITIONS AND REQUIRE <br />MENTS REPRESENTED ON THUS DOCUMENT THE UNDER <br />SIGNED F URTHER AGREES TO DO ALL WORKS IN STRICT COM <br />PLIANCE WITH ALL CITY OF 0140%0ORUINANCES AND STATE <br />OF MINNESOT fiL111.01M,('0UEREQUIREME%TS <br />I <br />TI <br />App+ �, (� of 0" <br />