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CITY of ClitONn PERMIT N� = 5200 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- 57 �$ _� -- <br /> �-- -�- S L_r�N�� <br /> ZONING DISTRICT SITE ADDRESS �--�-�� �+ �� � r��� <br /> � �J LEGAL DESCRIPTION: PROP. ID. L-3 ' � ��7 '.23 ' � �OZ� <br /> LOT BLOCK SUBDIVISION <br /> FIRE ZONE <br /> WNER (Name) (Address) }.f��, J; �/��,,�,� (Phone)� J <br /> �q �?� <br /> VAR. DATE � = I� �� -"`- /V �C�� ,_�C �� I A ` (c::` <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 (Firm) (Address) (Phone) <br /> 15 t,�;►1��' <br /> PROPOSEDSETBACKS <br /> FRONT R.SIDE _. TYPE OF WORK ewr Addition Remodel Renovate <br /> /E` Z-`J <br /> REAR LSIDE �� �`;�,�;� <br /> JEA����1��'�. � � - <br /> E;�� f CONST. TYPE BLDG. SIZE EST.CONST.VALUATION <br /> LAK� WETLANDS <br /> ,- �,+ <br /> ' � L. ��; W. Z,..� Ht.�� �� ��3+ F�a <br /> ACCESS RESIDENTIA STORIES B 1 2 3 PERMIT FEES ,�/ <br /> �-� BLDG. PERMIT .3L�!' , �=�<� <br /> NEW EXISTING DWELL. BDRMS/FLR - <br /> AGENCY-APPROV. DATE uNiTs � STATE FEE L�: ��" <br /> CITY GAR.STALLS SEPTIC � ��_, <br /> ATT. <br /> APP. DATE PLAN REVIEW I. � <br /> COUNTY �Er. PENALTY <br /> DOCK ��!` E ` <br /> STATE <br /> NON-RESID. PROPOSED USE PARK FEE �f` <br /> �� c�L <br /> PR. EASEMENT oCC. j����,� �� � 't�(L�T�Z�; �SAC CHARGE <br /> C LASS. <br /> STORIES COUNCIL } <br /> APP. DATE TOTAL DUE /"�C�� �� <br /> REMARKS: <br /> INSPECTION REQUIRED WORK REQUIRING ACKNOWLEDGEMENT <br /> FOOTING before pour 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 /> 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 AGREES TO DO ALL WORKS IN STRICT COM- <br /> WATER <br /> JECT TO PENALTY. PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br /> GRADING& FILLING <br /> INSPECTION HOURS 473-7357 OF MIN ESO A BUI CODE REQUIREMENTS. <br /> CALL8 - 12 A.M. INSP. 1 -4 P.M. <br /> CALL 1 - 4 P.M. INSP. NEXT DAY ELECTRICAL from State <br /> Signatu Date /�� <br /> COPY: WHITE—FILE GREEN—FINANCE ,-�. ; <br /> CANARY—INSPECTOR GOLD—RECEIPT { <br /> PINK—ASSESSOR Approved City of Orono <br />