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CITY of OR()NO <br />Building Permit <br />AND APPLICATION FOR CERTIFICATE OF OCCUPANCY <br />P.O. BOX 66. CRYSTAL BAY. MN 55323 473-7357 <br />F <br />NING Q{Sjr�iICT <br />E DFPARTM NT <br />POST OFFICE _ <br />VAR. DATE <br />COND. USE DATE <br />LOT AREA <br />WIDTH DEPTH <br />( q�� <br />PROPOSED SETBACKS' <br />FRIP96 i R. SIDE E— 7 <br />REAR L SIDE / I <br />0100, <br />LAKE WETLANDS <br />ACCESS <br />EW EXISTING <br />A ENCY- PROV DATE <br />CITY <br />COUNTY <br />LTRIVATE <br />EASE MEN <br />REMARKS <br />PERMIT NO. <br />DATE ISSUED <br />SITE ADDRESS 9 50 l 1lam- e�j L;CAe- <br />PROPERTY IDENTIFICATION NO (PID) -Q-7 / I — 21 <br />LOT -T BLOCK I SUBDIVISION <br />5743, <br />q-q-K <br />✓e— <br />ER (Name) (Address) <br />(Phone) <br />yz <br />od r ri5 Ca . <br />FARCHITE <br />Po. <br />�7� <br />T/ENGINEER - Must Certify Multi -Family. Commercial d Industrial Constr c to Plans <br />(Firm) (Address) <br />(Phone) <br />BUILDER (Firm) (Address) <br />(Phone) <br />Sat ti' e C-5 w r) e r <br />TYPE OF WORK New Addition Remodel <br />Renovate <br />47S 1 <br />CONST. TYPE <br />BUILDING SIZE <br />Estimated C • ., n Valuation <br />n'ie <br />L (vo w 3Z Ht <br />000. UU <br />OCCUPANCY <br />PERMIT FEES <br />CLASSIFICATION <br />Oa <br />BLDG. PERMIT 5P3. <br />STATE FEE _ 0 <br />PLAN REVIEW <br />DWELL. <br />UNITS <br />STORIES B (D 2 3 <br />G STALLS <br />NUMBER OF B D OO�M� S <br />_� <br />O / <br />SEPTIC —� <br />DET. <br />SAC CHARGE <br />APP. DATE <br />SEWER UNIT <br />PROPOSED USF <br />PARK FEE <br />--- ------ <br />PENALTY <br />FACOUNCIL <br />PP DATE <br />OTHER <br />i )TAL DUE <br />INSPECTION REQUIRED <br />FOOTING before ?our <br />.... FRAMING rough In <br />... INSULATION <br />... WALLBOARD before taping <br />.... FINAL before occupancy <br />1. .... SITE INSPECTION <br />WORK BEYOND OR WITHOUT A RE- <br />OUIRED INSPECTION WILL BE SUB <br />JECT TO PENALTY <br />INSPECTIONS MUST BE CA' -LED -IN <br />24 HOURS IN ADVANCE <br />WORK RFJUIRING <br />SEPARATE PERMITS <br />PLUMBING <br />MECHANICAL <br />WELL ............ I...I...... <br />SEPTIC .. ............... <br />SEWER ............. ❑ <br />WATER ...... ❑ <br />GRADING & FILLING ...... ❑ <br />FIRE <br />COPY WHITE -FILE GREEN-FtNANCF <br />CANARY INSPECTOR GOLD RECEIPT <br />PINK ASSESSOR <br />troar�nq a %&, co IK ror7156r4470 <br />ACKNOWLEDGEMENT <br />THE i,NUERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br />THE REAL IMPROVEMENTS SPECIFIED AND DECLARES <br />ONDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT <br />ANC:E OF ALL INFORMASION CONDITIONS AND REQUIRE. <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 />OF MINNESOTA BUILDING CODE REQUIREMENTS <br />......... ❑ � ltAst�y X� <br />Signature Dare <br />Approved C.ly of Orono <br />