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CITY of ()IZ()N() PERMIT Nn _ 5615 I <br /> Building Permit � <br /> DATE ISSUED �� ���'/ <br /> AND APPLICATION FOR CERTIFICATE OF OCCUPANCY EXPIRES <br /> P.O. BOX 66, CRYSI"AL BAY, MN 55323 473-7357 ,�- , <br /> ZONING DISTRICT SITEADDRESS ��'� �'Z-� � <br /> LEGAL DESCRIPTION: PROP. ID. �" — � � <br /> LOT BLOCK SUBDIVISION <br /> FIRE ZONE <br /> WNER (Namey, (Address) . (Phone) <br /> VAR. DATE � ��Gvi"+t!( �f �'• <br /> ARCHITECT/ENGINEER — Must Certify Multi-Family, Commercial & Industrial Construction Plans <br /> COND. USE DATE ERT.NO. <br /> (Firm) (Address) (Phone) <br /> LOT AREA <br /> WIDTH DEPTH BUILDER (F� m) (Address) ���, (Phone) <br /> PROPOSED CKS �� aC�� �5� c'� ' aQy <br /> FRONT . DE TYPE OF W New Addition Remodel enovate <br /> � <br /> REAR L.S DE �1 S�� ` --� '����1_� <br /> //l- <br /> CONST. TYPE BLDG.SIZE EST.CONST. VALUATION <br /> LAKE E S �� <br /> L. W. Ht. �// (.'��, <br /> ACCESS RESIDENTIA STORIES a � z s PERMIT FEE /�, �j <br /> BLDG. PERMIT ((�' •� <br /> NEW EXISTING DWELL. BDRMS/FLR <br /> AGENCY-APPROV. DATE UNITS STATE FEE .� S�) <br /> CITY GAR.STALLS SEPTIC <br /> ATT. APP. DATE PLAN REVIEW <br /> COUNTY �ET. PENALTY <br /> DOCK <br /> STATE NON-RESID. PROPOSED USE PARK FEE <br /> PR. EASEMENT oCC. SAC CHARGE <br /> C LASS. <br /> STORIES COUNCIL <br /> APa. �ATE TOTAL DUE � q ��`�� <br /> REMARKS: �" � - � <br /> C��C� . <br /> INSPECTION REQUIRED WORK REQUIRING ACKNnWLEDGEMENT <br /> FOOTINGbeforepour SEPARATE PERMITS <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br /> FRAMING rough-in <br /> INSULATION PLUMBING THE REAL IMPROVEMENTS SPECIFIED, AND DECLARES <br /> WALLBOARD Before Taping MECHANICAL — UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> WELL ANCE OF ALL INFORMATION, CONDITIONS AND REQUIRE- <br /> L�FINAL before occupancy <br /> SEPTIC <br /> MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER— <br /> WORK BEYOND OR WITHOUT A RE- SEWER <br /> QUIRED INSPECTION WILL BE SUB- SIGNED FURTHER AGREESTO D ALL WORKS IN STRICTCOM- <br /> JECT TO PENALTY, WATER <br /> GRADING& FILLING PLIANCE WITH ALL CITY OF O O ORQ. A ES AND STATE <br /> INSPECTION HOURS 473-7357 <br /> CALL 8 - 12 A.M. INSP. 1 -4 P.M. OF MINNESOT UILD D RE RE NTS. <br /> CALL 1 - 4 P.M. INSP. NEXT DAY ELECTRICAL from State <br /> �� <br /> Signature �� ' ��l��Date '� � � <br /> COPY: WHITE—FILE GREEN—FINANCE <br /> CANARY—INSPECTOR GOLD—RECEIPT � <br /> PINK—ASSESSOR Approved � � ' �ty of Orono <br /> i <br />