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(�ITYof nIZO�O PERMIT xn 5025 � <br /> Building Permit DATE ISSUED �- z� -�� <br /> AND APPLICATION FOR CERTIFICATE OF OCCUPANCY EXPIRES <br /> P.O. BOX 66, CRYSI-AL BAY, MN 55323 473-7357 <br /> ZONING DISTRICT SITEADDRESS I1o25 �1�o�r � �e�v�'� 1�C� <br /> LEGAL DESCRIPTION: PROP. ID. I 1 — I�1 ` 2-3 1� �bb�� <br /> LOT BLOCK SUBDIVISION <br /> FIRE ZONE <br /> WNER (Name) (Address) (Phone) <br /> VAR. DATE `� ��jr� <br /> ARCHITECT/ENGINEER — Must ertify 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 /> PROPOSEDSETBACKS <br /> �L C ���-3- y�� <br /> FRONT R.SIDE TYPE OF WORK New Addition Remodel enov <br /> REAR L.SIDE t\'� �CC� <br /> CONST. TYPE BLDG. SIZE EST. CONST. VALUATION <br /> LAKE WETLANDS <br /> S�/'� � c <br /> L. W. Ht. � (J(,/� � <br /> ACCESS RESIDENTIA STORIES e i z a PERMIT FEES <br /> BLDG. PERMIT �(� �O <br /> NEW EXISTING DWELL. BDRMS/FLR <br /> AGENCY-APPROV. DATE UNITS STATE FEE ,S� <br /> CITY GAR.STALLS SEPTIC PLAN REVIEW <br /> ATT. APP. DATE <br /> COUNTY oET. PENALTY <br /> DOCK <br /> STATE <br /> NON-RESID. PROPOSED USE PARK FEE <br /> PR. EASEMENT oCC. <br /> SAC CHARGE <br /> C LASS. <br /> STORIES COUNCIL �� <br /> APP. DATE TOTAL DUE �3, <br /> REMARKS: '��d,(Z Cy� �K� STIw Cy �p�� �� � ,Q�,�!/ <br /> INSPECTION REQUIRED WORK REQUIRING ACKNOWLEDGEMENT <br /> FOOTING before pour SEPARATE PERMITS <br /> THE UNDERSIGNED HEREBV REQUESTS PERMISSION TO MAKE <br /> FRAMING rough-in <br /> INSULATION PLUMBING THE REAL IMPROVEMENTS SPECIFIED, AND DECLARES <br /> WALLBOARD Before Tapmg MECHANICAL UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> WELL ANCE OF ALL INFORMATION, CONDITIONS AND REQUIRE- <br /> F 1 NA L 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 STRICT COM- <br /> JECT TO PENALTY. WATER <br /> GRADING& FILLING PLIAN WITH ALL CITY O O N ORDINANCES AND STATE <br /> INSPECTION HOURS 473-7357 OF INNE T BUI DI G OD RE UIREMENTS. <br /> CALL 8 12 A.M. INSP. 1 -4 P.M. <br /> CALL 1 - 4 P.M. INSP. NEXT DAY ELECTRICAL from State <br /> Signatur � Date <br /> COPY: WHITE—FILE GREEN—FINANCE <br /> CANARY—INSPECTOR GOLD—RECEIPT / <br /> PINK—ASSESSOR Approved L� City of Orono <br />