HomeMy WebLinkAbout1992-004314 - tear-off/re-roof � PERMIT
�ITY OF ORONO '" � PERMIT TYPE:
335 Brown Rd. South • P.O. Box 66 Permit Number: �iti�..'���t�j,�G
Crystal Bay, Minnesota 55323 Date Issued: t:���i37/�ii
�612) 473-7357
SITE ADDRESS:
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DESC IPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: — A�F1 i c�nt• —
PAT�H JiaHN
�i_=�5 F`Fii F�F'EC:T AVE
���ti�Ni] MN 5�:j'31
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �
CITY OF ORONO - BIIILDING �ERMIT APPLICATION
, �
Total Fee: $ � � � ��� Date Received:
� Date Approved:
Entered sy: ��% y3��
Permit#:
AT•T• INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-of f Li st Encl.osed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) O�+1NER or CONTRACTOR
� '(�`����'"�� ��l,`� ; d(�;�c'� Z I P:
JOB SITE ADDRESS.�
r (work) �5 -�����
N� OF OWNER: ��� �a �i�rLl� PHONE: (home)�"�`75 5
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MAII�ING ADDRESS: � /1.,� � �i . I�.����Tt���l J CITY: (,'�1���,�,(1'� ZIP: (+ � �
CONTRACTOR: S�t.r� PHONE:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PH��=
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
AI �� ) �� .�-,
PROPOSED WORK (describe in detail) : /� ��-O �--�c��
STORIES: � SQ. FEBT OF EACH FLOOR: ��✓� � C���C!K�y �
NO. OF BEDROOMS:� GARAGE STAI.LS: ATT. � DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ �.�1 �y
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City and with the State Building Code; that I
understand this is not a permit and work is not to start without a permit; and
that the work will be in accordance with the approved plan.
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APPLICANT'S SIGNATDRE: C-� ��L�IJUL---� '-�����%�__ DATE: .� ' �` �'�
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� _ � � On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would 3ike to inform you that your request for a permit or
license from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
1. The information you furnish wi3.1 be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or license.
3. The information may be shared with other Iocal, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council, act�on
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required to process this application or
permit.
Jp��,� � ��'� ��.
First Middle Last
) � � ��z�T� � - �� -
Aaa S S ��� �
���� 1��
City State Zip
�.-f� � �- �-��-�
Phone
I understand my rights as stated above.
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Signa re .
BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING