Laserfiche WebLink
CA PERMIT NE: _ rM <br />Building Permit <br />DATE 15SUED�_'�-_�.__ <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />EXPIRES <br />P.O. BOX 66, CRYSTAL HAY, MN 55323 473-7337 , <br />ZONING DISTRICT SITE ADDRF.SS—a 3`1`�. <br />LEGAL DESCRIPTION PROP. ID % e')n <br />LOT BLOCK SUIIUI VI ;iOrJ _ <br />FIRE ZONE — -- ---- -- <br />VAR. DATE `— <br />COND USE DATE <br />LOT AREA <br />WIDTH DEPTH <br />PROPOSED SETBACKS _ <br />FRO S <br />4:7 41-0 <br />R. <br />�t-- L siL Sioy <br />8 <br />LAKE WETLANDS <br />ACCESS <br />NEW EXISTING <br />AGENCY-APPROV DATE <br />CITY <br />COUNTY <br />STATE <br />PR EASEMENT <br />REMARKS <br />,'JiJER (Ndmr1 IAr1,4 ssl IPhrinel <br />i)RA AC,f�e�J �, . + �f 7/ - Y$ z <br />ARCHITECT/F.NGINEE R Must Certify Muni Family, Commercial h Industrial Corstruttlun PI,Ins <br />E R T. NO - <br />(Firm) -IAvIdress) (Phone) <br />BUILDER <br />IFnml <br />(A• Tress) <br />T $� E(.cior A jC <br />IPhonel <br />TYPE OF VJORK New <br />tlon Remodel <br />Proova <br />W ".) s <br />Acf 1TECNr <br />CC)I•),T TVr[T111 <br />ur, 51/[ <br />F',T ct r.;t �•n�l nT:c)'� <br />00 <br />RVAUENTIAI <br />sTururs 11 1 <br />:1 <br />PERMIT FEES <br />50 <br />8Ln)G PERMIT <br />OWEI L <br />BU(FMs•FLIA <br />aD <br />U'nTS <br />STATE FEE <br />_ <br />(,Ali STALL' <br />SEPTIC--_�-- <br />-_ <br />REVIEW <br />PLAN REVIEW <br />nTT <br />APP <br />PENALTY <br />vc,"J nF51U <br />Plu)'r;;,Eu u;t <br />PARK FEE <br />_`— -- <br />- - - <br />SAC CHARGE <br />OCC <br />Ct ASS <br />-.-._ _._ <br />;TUHIES - <br />COUNCIL ------ <br />-- -- -- <br />Gfl <br />APP DATE <br />TOTAL DUE <br />INSPECTION REQUIRED <br />WORK REQUIRING <br />SEPARATE PEnPAITS <br />FOOTINGbelaepuu, <br />FRAMING rouvh'n <br />INSULATION <br />PLUMBING <br />WALLBOAND Betu'e T.y,.nll <br />MECIIANFCAL .- <br />FINALtwlu•euturfaw <br />SEPTIC -- <br />4K BEYOND OR WITHOUT A nE <br />SEW( H <br />4ED INSPECTION WILL BE SUIJ <br />WAT[n <br />TO PENALTY <br />GHA[11NF, b 1 It . INt, <br />eECIION /1Ut1H, 413130/ <br />LB )JAM INSP I aPM <br />1 4 PM INN#' NI XI DAY <br />ELE(.inlCA1 I•,,mS)nla <br />U0I171 I Il I (Alt I N I INAN111 <br />i.1,:.11, IN I'I1.1O1/ ld)FU /1([:EIPt <br />No, A(y.F t SUI, <br />ACKNOWLEDGEMENT <br />a <br />8 <br />THE UNUEHSI(,NEU HEREBY REOUESTS I'E(.MISSION TO MAKE <br />THE REAL IMP14OVEMENTS SPECIFIED AND DECLARES ' <br />UNUER PLNAL TY OF LAW ACKNOWLEUGCMENT AND ACCEPT <br />ANCE OF All INFORMATION. CONDITIONS tND nEOU1RE <br />MENTS HEPHLSE.NTlU ON THIS DOCUMENT THE UNDER <br />AGNEU FlJilluE 11 nt,nEt S 10 UO AI 1 W(IHKS IN STRICT CUM <br />r, IANCI WITH ALL t ITV ul ORONJUI1D1NANCFS ANt) STATE <br />to MINNt:4)fAjsulnNL,(t1UlNE(lUtTtM(N15 <br />.n,. e _ l •, . (./ y L S.� ; c to t <br />J IA � � " <br />