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CITY of ORO)N <br />Building Permit PERMIT NO. 5777, <br />AND APPLICATION FOR CERT!FICATE OF OCCUPANCY DATE ISSUED <br />P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br />ZONING DISTRICT SITE ADDRESS �� � L �) �--e <br />FIRE DEPARTM T <br />0. a, <br />roST F ICE <br />z <br />VAR.DATE <br />COND. USE DATE <br />LOT AREA _ a-C"' <br />. 5 4cA, c. <br />WIDTH I DEPTH <br />Q. vv <br />PROPOSED SETBACKS <br />FRONT R. SIDE <br />REAR L. SIDE <br />L AKE rr WETLANDS <br />$I q'("1.- <br />ACCESS <br />NEW �XISTIANTEAGENCYAPP <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />REMARKS - <br />PROPERTY IDENTIFICATION NO. (PID) 'a <br />LOT BLOCK SUBDIVISIO y! <br />OWNER (Name (Address) S `1 o -K.i? (Phone) <br />� _mot• C�- <br />ARCHITECT/ENGINEER - Mus Certify III -Family, Itommercial & Industrial Construction Plans <br />(Firm) (Address) (Phone) <br />BUILDER (Firm) (Address) (Phone) <br />C�- <br />TYPE OF WORK w Addition Remodel Renovate <br />CONST TYPE BUILDING SIZE <br />W. '�j , HII;X <br />OCCUPANCY <br />CLASSIFICATION <br />DWELL. STORIES B (t ) 2 <br />UNITS <br />GAR STALLS NUMBER OF BEDROOMS <br />ATT <br />DET. SEPTIC <br />APP. DATE <br />PROPOSED USE <br />ICOUNCIL <br />APP DATE <br />IN PECTION REQUIRED <br />WORK REQUIRING <br />SEPARATE PERMITS <br />... FOOTING before pour <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 />QUIRED INSPECTION WILL BE SUB- <br />JECT TO PENALTY. <br />WATER <br />INSPECTIONS MUST BE CALLED -IN <br />GRADING 8 FILLING <br />24 HOURS IN ADVANCE. <br />FIRE <br />COPY WHITE -FILE GREEN -FINANCE <br />CANARY -INSPECTOR GOLD. <br />RECEIPT <br />PINK -ASSESSOR <br />MoMrvn hy. 6 AM Cc rM I6111 U14410 <br />:i <br />g.-I <br />EJ <br />3 <br />Estimated Construction Valuation <br />�` 06 (2j <br />PERMIT FEES <br />BLDG. PERMIT ___ZaS <br />STATE FEE _�_ �/-? - (-n <br />PLAN REVIEW <br />SAC CHARGE !_�� C) <br />SEWER UNIT <br />PARK FEE <br />PENALTY <br />OTHER <br />TOTAL DUE / S <br />ACKNOWLEDGEMENT <br />THE UNDERSIGNED HEREBY REQUESTS 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 />PLIAN WITH ALL _CITTYY^OF O �N�i• ORDINANCES AND STATE <br />OF MIN F SOTA BUIL➢19G COU1fEr70IREMENTS <br />,Iv of Orono <br />I <br />