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CITY of ORONI) <br />Building Permit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br />P <br />DISTRICT <br />as <br />RTMENT <br />L- <br />POST OFFICE <br />VAR.DATE <br />COND. USE DATE <br />LOT AREA <br />WIDTH DEPTH <br />PROPOSED SETBACKS: <br />F NT R. SID <br />REAR L. SIDE <br />LAKE WETLANDS <br />ACCESS <br />NEW EXISTING <br />AGENCY•APP <br />CIT`r <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />REMARKS: <br />PERMIT NO. 5806 I <br />DATE ISSUED 7.) -19 - AN' <br />SITE ADDRESS <br />PROPERTY IDENTIFICATION NO (PID) <br />LOT BLOCK SUBDIVISION <br />OWNER :c, DY(Name) (Address) (Phone) <br />Ju <br />o� <br />ARCHITECT/ENGINEER - IMust Certify Multi Family. Commercial 8 Industrial Construction Plans <br />(Firm) (Address) (Phone) <br />BUILDER (Firm) (Address) (Phone) <br />837/ C1 r I f use a1vc� <br />TYPE OF WORK Addition Remodel Renovate <br />[IZANSOTTYPE1 BUILDING SIZE Est mated Construction Valuation <br />L. .3 ( ( w. to I Ht I 13 goo <br />OCCUPANCY <br />PERMIT FEES <br />CLASSIFICATION <br />M — <br />BLDG. PERMIT <br />Q <br />/8 SD <br />DWELL. <br />STORIES B t 2 3 <br />UNITS <br />STATE FEE <br />��•.__ <br />GAR. STALLS <br />NUMBER OF BEDROOMS <br />ATT. <br />PLAN REVIEW <br />__ <br />DET. <br />SEPTIC <br />SAC CHARGE <br />__ <br />APP. DATE <br />SEWER UNIT <br />_. --- <br />PROPOSED USE <br />PARK FEE <br />PENALTY <br />COUNCIL <br />APP. DATE <br />OTHER <br />INSPECTION REQUIRED <br />WORK REQUIRING <br />SEPARATE PERMITS <br />❑ ...... FOOTING before pour <br />El...... FRAMING rough -In <br />PLUMBING <br />❑ ...... INSULATION <br />MECHANICAL <br />❑ ...... WALLBOARE before taping <br />El ...... FINAL belure occupancy <br />WELL <br />❑ ...... SITE INSPECTION <br />SEPTIC... <br />WORK BEYOND OR WITHOUT A RE- <br />SEWER . ........... <br />OUIRED INSPECTION WILL BE SUB- <br />JECT TO PENALTY <br />WATER <br />GRADING & FILLING <br />INSPECTIONS MUST BE CALLED -IN <br />24 HOURS IN ADVANCE <br />FIRE <br />COPY WHITE-FILF GREEN FINANCE <br />CANARY INSPECTOR GOLD -RECEIPT <br />PINK ASSESSOR <br />IkootWn On% & AW Cc Inc ts111 %14470 <br />TOTAL DUE <br />ACKNOWLEDGEMENT <br />THE UNDERSIGNED HEREBY REUUESTS 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 REOUIRE- <br />MENTS F:PRESENTED JN 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 BUILDING CODE RE UIREMENTS <br />SignatureDete <br />of Orono <br />