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()ltO NO <br />Building Perinit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66. CRYSTAL BAY. MN 55323 473-7357 <br />ZONING DISTRICT <br />1�--) <br />FIR DEPARTM NT <br />1,71r, LaKt. <br />POST OFFI <br />VAR DATk <br />COND. USE DATE <br />LOT ARE P C 1 <br />WIDTH �� DEPTH r <br />r <br />PROPOSED SETBACKS <br />FRON d / R. SIDE / <br />REAR L. SIDE / <br />LAKE WETLANDS <br />of d e <br />ACCESS <br />�� <br />6L w' EXISTING <br />AGENCY•APPROV. DATE <br />CITY <br />COUNTY <br />STATE <br />PRIVATE EASEMENT <br />REMARKS <br />SITE ADDRESS 7-3o OCI'c a z <br />PROPERTY IDENTIFICATION NO IPID) <br />PERMIT NO. 57351 <br />DATE ISSUED Lei S <br />LOT _BLOCK <br />SUBDIVISION <br />OU <br />OWNER (Name) <br />(Address) <br />(Phgpey, 97' <br />Al le <br />ARCHITECT/ENGINEER - Must Certify Multi -Family. <br />Commercial & Indust al Construction Plans <br />(Firm) (Address) <br />(Phone) " `' <br />4 - <br />BUILDER (Firm) (Address) <br />(Phone) <br />rA <br />TYPE OF WORK ew Addition <br />Remodel <br />Renovate <br />r?C e <br />CONS7T TYPE <br />BUILDING SIZE <br />Esti ated Construction Valuation <br />l f!) IC <br />L W. <br />Ht <br />O i O U <br />OCCUPANCY <br />PERMIT FEES <br />CLASSIFICATION <br />BLDG. PERMIT <br />L <br />DWELL <br />STORIES g t <br />j <br />_ - <br />UNITS <br />STATE FEE <br />PLAN REVIEW <br />: as <br />STALLS <br />NUMBER OF BEDROOMS 41 <br />DIET <br />SEPTIC <br />SAC CHARGE <br />/1 <br />0 <br />APP DATE <br />SEWER UNIT <br />_Y3 - <br />PROPOSED USE <br />PARK FEE <br />PENALTY <br />COUNCIL <br />APP DATE <br />OTHER <br />INSPLCTION REQUIRED <br />WORK REQUIRING <br />SEPARATE PERMITS <br />..... FOOTING before pour <br />.... FRAMING rough -in <br />PLUMBING <br />.... INSULATION <br />MECHANICAI. <br />..... WALLBOARD before taping <br />�...... FINAL before occupancy <br />WELL <br />❑ ...... SITE INSPECTION <br />SEPTIC <br />WORK BEYOND OR WITHOUT A I•I <br />SEWER <br />OUIRED INSPECTION WILL BE St N <br />JECT TO PENALTY <br />WATER <br />INSPECTIONS MUST BE CALLED Ir4 <br />GRADING A FILLING <br />24 HOURS IN ADVANCE <br />FIRE <br />COPY WHITE -FILE GREEN FINANCE <br />CANARY -INSPECTOR GOLD <br />RECEIPT <br />PINK ASSESSOR <br />er"lio" 1101.% a M CO r- ,N, 7, jar "?a <br />TOTAL DUE <br />ACKNOWLEDGEMENT <br />IIIL UNDERSIGNED HEREBY REQUESTS PEFtMISSION 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 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 />L_J <br />OF MINNESOTA BUILDING CODE REQUIREMENTS <br />C/ <br />Aoproveo C,tv of Orono <br />