HomeMy WebLinkAbout1987-8866 - general permit GENERAL PERMIT CITY PERMIT I�T� 8 S 6 6
CITY OF ORONO
P.O. BOX 66 Date �
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner ��-3'��'-r} Address �`�� ! J�CJ�-�"J Pl��`�f �� ��
Contractor ���E'I��� L'C'�e'/� Address %���/� /G�-/ /�
City License No. ��,� City
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE: � W ❑ ADDITION ❑ REPAIR ❑ REMODEL
Inside Plumbing(#fixtures ) Fee $ Water Well Fee $ �Q ��
Water Meter(Size ) Fee $ Mechanical Equipment Fee $
Meter# Fireplace/Wood Stove Fee $
Remote# Moving/Lifting Buildings Fee $
Municipal Water Connection Fee $ Land Alteration (Excavation,
❑ Copper ❑ Grading, Filling, etc.) Fee $
Design Review Fee $
Municipal Sewer Connection Fee $
Fire Fee $
❑ PVC ❑ Cast ❑
Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $
- Other: Fee $
On Site Spetic System Fee $
After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
State Surcharge: Fee $ '��
The undersigned hereby acknowledges receipt of this limited permit, �� ��
including acceptance of all special information, terms, conditions or Total Amount Paid to City Fee $
requiremencs H-ritten above. The undersigned understands and agre�
under penalty of law that this permit is stricdy limited in scope to the work,
activiry or improvement specified;that this permit does not grant any
authority to do work or ac[ivities requiring separate permit approvals;and
that this permit does notgrantauthonry to violate any provision ofany City
ordinance or Sta[e law,rule or regulaboa All work shall be done in strict This permit is not valid until the proper fee is paid and it is approved
compliance with all Ciry ordinances, building codes and/or health
department regulaeons,and shall be subject to inspection,approval or by an authorized Ciry Official.
rejection by[he City.Whenever so ordered,the undersigned agrees to
correct am work foun to be in vialation of the conditions of this permit.
Signature o pplicant
rv J ������-- Signature of City Offici
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Code: White—Fi►e Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanPs Receip[