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CITY of OIZONO PERMIT Nn � 5120 i <br /> Building Permit - <br /> DATE ISSUED � — ��- � �� <br /> AND APPLICATION FOR CERTIFICATE OF OCCUPANCY EXPIRES <br /> P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 � � <br /> ZONING DISTRICT SITE ADDRESS <br /> / n , / � LEGAL DESCRIPTION: PROP. ID. rS" — // � — � 3 �" -3 l '— U U L� <br /> 4 �� LOT BLOCK SUBDIVISION <br /> FIRE ZONE <br /> WNER (Name) (Address) (Phone) <br /> VAR. DATE ���� I � � — �� <br /> ARCHITECT/ENGINEER — Must Certify Multi-Family, Commercial & Industrial Construction Plans <br /> COND. USE DATE ERT.NO. <br /> (�) �� O (Address) � (Phone) <br /> LOT AREA <br /> WIDTH DEPTH BUILDER (Firm) (Address) (Phone) <br /> PROPOSEDSETBACKS <br /> FRONT R.SIDE TYPE OF WORK New Addition Remodel Renovat <br /> R E A R L.S I D E ,/L.Q/1.�1� <br /> CONST. TYPE BLDG. SIZE E T. CONST. VALUATION <br /> LAKE WETLANDS <br /> � �(� <br /> L. W. Ht. 1 �'G� <br /> ACCESS RESIDENTIA STORIES B 1 2 3 PERMIT FEES <br /> BLDG. PERMIT , �J d <br /> NEW EXISTING DWELL. BDRMS/FLR <br /> AGENCY-APPROV. DATE urvlrs STATE FEE , C� (� <br /> CITY GAR.STALLS SEPTIC <br /> ATT. APP. DATE PLAN REVIEW <br /> COUNTY �ET. PENALTY <br /> DOCK <br /> STATE NON-RESID. PROPOSED USE PARK FEE <br /> PR. EASEMENT oCC. SAC CHARGE <br /> C LASS. <br /> STORIES COUNCIL T <br /> APP. DATE TOTAL DUE � � . ��/ <br /> REMARKS: <br /> INSPECTION REQUIRED WORK REQUIRING ACKNOWLEDGEMENT <br /> FOOTING before pour SEPARATE PERMITS <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br /> FRAMING rough-in <br /> INSULATION PLUMBING THE REAL IMPROVEMENTS SPECIFIED, AND DECLARES <br /> WALLBOARD Before Taping MECHANICAL UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> WELL ANCE OF ALL INFORMATION, CONDITIONS AND REQUIRE- <br /> F INA L before occupancy <br /> SEPTIC MENTS REP ESENTED ON THIS DOCUMENT. THE UNDER— <br /> WORK BEYOND OR WITHOUT A RE- SEWER <br /> QUIRED INSPECTION WILL BE SUB- SIGNED FURTH AGREES TO DO ALL WORKS IN STRICT COM- <br /> WATER <br /> JECT TO PENALTY, PLIANCE W TH ALL C Y OF ORONO ORDINANCES AND STATE <br /> GRADING& FILLING <br /> INSPECTION HOURS 473-7357 <br /> CALL8 - 12 A.M. INSP. 1 -4 P.M. OF MINNE A B LDING DE REQUIRE ENTS. <br /> CALL 1 - 4 P.M. INSP. NEXT DAY ELECTRICAL from State <br /> Sign Date / �/z �� <br /> COPY: WHITE—FILE GREEN—FINANCE <br /> CANARY—INSPECTOR GOLD—RECEIPT <br /> PINK—ASSESSOR Approved � City of Orono <br />