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CITY of ORONO <br />Building Permit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br />F <br />ING ISTRICTDEPARTMENT <br />POST OFFICE <br />VAR. DATE <br />COND. USE DATE <br />LOT AREA t I <br />WIDT 0� ", DEPTH <br />/ <br />PROPOSED SETBACKS <br />FRO S R. SIDE <br />RE R L. SIDE V / <br />LAKE WETLANDS <br />ACCESS <br />EXISTING <br />AG NCY-APPROV. DATE <br />CITY <br />CO N Y <br />STATE <br />PRIVATE EASEMENT <br />REMARKS: <br />PERMIT NO. 5788 <br />DATE ISSUED 4 -- S_ <br />SITE ADDRESS�LP <br />PROPERTY IDENTIFICATION NO (PID11 <br />LOT____r_S�_BLOCK 1 SUBDIVISION ICE 1142cl <br />[OINER It <br />(Name) (Address) - 3 (Phone) / <br />{ i'iLL`�C�•� I ���)r �]Gl L11 • Yftrv.nhu ft*� <br />CHITECT/ENGINEER - Must Certify Multi -Family. Commercial & Industrial C4111struction Plans <br />(Firm) IAddressl (Phone) <br />BUILDER (Firm) <br />r <br />(Address) (Phorlel <br />TYPE OF WORK eW Addition <br />Remodel <br />Renovate <br />CONST. TYPE <br />BUILDING SIZE <br />Estimated Construction Valuation <br />F <br />L. •� W. �� � Hr. <br />1 o <br />oo0 <br />OCCUPANCY <br />PERMIT FEES <br />CLASSIFICATION <br />BLDG. PERMIT <br />, 100 <br />DWELL. <br />STORIES B t 20 3 <br />UNITS <br />STATE FEE <br />/, <br />' �y <br />GAR. %ALLS <br />NUMBER OF BEDROOMS <br />ATT. <br />WLAN REVIEW <br />r n� <br />DET. <br />SAC CHARGE <br />c <br />SEPTIC / <br />APP. DATE <br />SEWER UNIT <br />_ <br />PROPOSED USE <br />PARK FEE <br />PENALTY <br />_._- <br />COUNCIL <br />APP. DATE <br />OTHER <br />IINCOECTION REQUIRED WORK REQUIRING <br />SEPARATE PERMITS <br />... FOOTING before pour <br />..... FRAMING rough -in PLUMBING L ................... <br />..... INSULATION MECHANICAL...................... <br />..... WALLBOARD before taping <br />...... FINAL before occupancy WELL ............................. <br />...... SITE INSPECTION SEPTIC ......................... <br />WORK BEYOND OR WITHOUT A RE- SEWER ❑ <br />OUIRED INSPECTION WILL BE SUB- WATER ❑ <br />JECT TO PENALTY. <br />❑ <br />INSPECTIONS MUST BE CALLED -IN GRADING & FILLING <br />24 HOURS IN ADVANCE. FIRE ❑ <br />COPY WHITE -FILE GREEN -FINANCE <br />CANARY -INSPECTOR GOLD -RECEIPT <br />PINK -ASSESSOR <br />MOohN. ►nb &Ach Co Inc 1612)5614alo <br />TOTAL DUE % //&7 T, <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 />PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br />OF MINNESOTA BUILDI CODE REQUIREMENTS <br />ro <br />S.gnatu'e Date <br />of Orono <br />