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GENERAL P�RNIIT CITY PERMIT N0 8 8 8 4 <br /> �C�['Y� OF' �i7.0I�t� <br /> P.O. BOX 66 Date I � � 1 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner �� `� ��Q�� Address ��vO ��1 �-���` (�� �r� <br /> Contractor ��—�-'�F � ��X�' l ��r�i�11� Address �� ��J I' �"� ` ��1�.� <br /> City License No. � I� City �v � ' '' , 'v ��`�`f�� <br /> REMARKS AND SPECIAL CONDITIONS <br /> �'"` ��,�OC.1� L�fC�V'eS <br /> PERMIT TYPE AND FEE: �[l NEW � ADDITION ❑ REPAIR ❑ REMODEL <br /> / \ <br /> Inside Plumbing(#fixtures ) Fee $ Water Well Fee $ <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ <br /> Meter# Fireplace/Wood Stove Fee $ � <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration(Excavation, <br /> ❑ Copper ❑ Grading, Filling,etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑ Cast ❑ <br /> Sprinkler S tem (Fire) Fee $ <br /> MW CC SAC Charge Fee $ � �–�-� <br /> Other: �� Fee $ �l�2� <br /> On Site Spetic System Fee $ <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ '�� <br /> 'Ilie undersigned hereby acknowledges receipt of this limited permit, (��f <br /> including acceptance of all special information, terms, conditions or Tota1 Amount Paid to City Fee $ �_ v <br /> reyuiremen[s written above. The undersigned understands and agrees <br /> under penalty of law[hat this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this permit dces not grant any <br /> �uthority[o do work or activities requinng separate permit approvals;and <br /> that this permit dces not grant authority to violate anr'provision of any City <br /> ordinance or State law,rule or regulation.All work shall be done in strict T'his permit is not valid until the proper fee is paid and it is approved <br /> compliance with all City ordinances, building codes and/or health <br /> department regulations,and shall be subject to inspection,approval or by an authorized City Ot�eial. <br /> rejection hy the City.Whenever so ordered.the undersigned agrees[o <br /> correct anv uork founcl to be in vialation of the conditions of this permit. <br /> Signature of Applicant <br /> f�� Signat re f City Official <br /> � � � <br /> � � <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanPs Receipt <br />