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CITY of ORONO _ _ _ _ <br /> Buildin Permit PERMIT NO. Jr�S� � <br /> g <br /> AND APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE ISSUED �-' l � ' �S <br /> P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br /> ZONING DISTRICT <br /> SITE ADDRESS �C_� <br /> PROPERTY IDENTIFICATION NO.(PID) � � 1 —' '"3� QO S <br /> FIRE DEPARTMENT LOT BLOCK SUBDIVISION <br /> POST OFFICE OWNER (Name) (Address) (Phone) <br /> �� � � <br /> VAR. DATE ARCHITECT/ENGINEE - Must Certify Multi-Family,Commercial& I d strial Construction Plans <br /> (Firm) (Address) (Phone) <br /> COND. USE DATE � � <br /> / <br /> LOT AREA BUILDER (Firm) (Address) (Phone) <br /> ��� �G U S,S ,Z S�f - � � � . <br /> WIDTH DEPTH <br /> TYPE OF WORK ew Addition Remodel Renovate <br /> PROPOSED SETBACKS: <br /> FRONT R. SIDE <br /> CONST. TYPE BUILDING SIZE Estimated Construction Valuation <br /> REAR L. SIDE <br /> L W. Ht. /C! ��� �• <br /> LAKE WETLANDS <br /> OCCUPANCY PERMIT FEES <br /> CLASSIFICATION <br /> ACCESS DWELL STORIES g � 2 3 BLDG. PERMIT ��-�`• �� <br /> UNITS , �'Q <br /> NEW EXISTING STATE FEE <br /> GAR.STALLS NUMBER OF BEDROOMS <br /> AGENCY-APPROV. DATE ATT. PLAN REVIEW <br /> CITY DET. SEPTIC <br /> APP. DATE SAC CHARGE <br /> COUNTY PROPOSED USE SEWER UNIT <br /> STATE PARK FEE <br /> PENALTY <br /> PRIVATE EASEMENT COUNCIL <br /> APP. DATE OTHER <br /> � TOTAL DUE � ��� ��� <br /> REMARKS: <br /> ����-+�'�— 6u.N�[�- � � �}��'^� <br /> INSPECTION REQUIRED WORK REQUIRING ACKNOWLEDGEMENT <br /> SEPARATE PERMITS THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br /> ❑ . . . . . . FOOTING before pour <br /> ❑ . . . . . . FRAMING rough-in PLUMBING ......................... ❑ THE REAL IMPROVEMENTS SPECIFIED. AND DECLARES <br /> ❑ . . . . . . INSULATION MECHANICAL....................... ❑ UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> ❑ . WALLBOARD before taping ANCE OF ALL INFORMATION. CONDITIONS AND REQUIRE- <br /> . . . . . <br /> WELL ............................... <br /> ❑ . . . . . . FINAL before occupancy <br /> ❑ . . . . . . SITE INSPECTION SEPTIC.............................. � MENTS REPRESENTEO ON THIS DOCUMENT. THE UNDER- <br /> WORK BEYOND OR WITHOUT A RE- SEWER.............................. � SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM- <br /> QUIRED INSPECTION WILL BE SUB- P�IANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br /> JECT TO PENALTY. WATER............. ❑ <br /> GRADING 8 FILLING ............... ❑ <br /> OF MINNESOTA BUILDING CODE REQUIREMENTS. <br /> INSPECTIONS MUST BE CALLED-IN <br /> 24 HOURS IN ADVANCE. FIRE................................. ❑ g • j ,� �✓ <br /> Si nature � Date�_` � � <br /> COPY:WHITE-FILE GREEN-FINANCE � <br /> CANARY-INSPECTOR GOLD-RECEIPT <br /> PINK-ASSESSOR Approved � City of Orono <br /> Brooklyn Prtg.&Adv.Co.Inc. (612)561�470 <br />