HomeMy WebLinkAbout1994-006505 - tear-off/re-roof PEI�'l�'��T
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ���:�_=..:-j:.�vt�
Permit Number: ��t_,w,�:;:;
Crystal Bay, Minnesota 55323 , -
(612)473-7357 � Date Issued: � �_;,,;k-;���;,:;
SITE ADDRESS: '
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: =Yr==°�. �_���E�.
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APPLICANT/PERMITEE SIGNATU ISSUED BY:SIGNATURE
CZTi' OF ORONO - BIIIZI�IN�T'R�iZT A.PPI.IC�T=ON
. Date Received:
�/ _ � _ ��/
Tctal. Fee: $ , -
Date A�nrove�:
�ntered Bv: �� ' �i � Pe�it� 4�' s �� � � - _- .
BLFORE PLAN REv=EW WIIS' BE Sg��
�.,T.7• INFpg�2*ION MIIST BS(SU�C�� a�S` Enclosed? �
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------------------- p�rT�1E?Jjor CONTQ.�CTOR
�_._E APPLIC�27T IS: (circ?e one) ( _ ' -
- � ZIP: :SS ;�.�f —
�� '� -.S% ;�C;:v"_ Ci�2� - - �2 ,r•v�i
.;OB SITE A�DR�SS: '� �
� (work) 7/� zkk -`�`l�5
PHON�E: �hozr�e) �i72 -�5�-i'
2iA2� OF OWNg``;"
/�'v�' t� FC+2�-� �
?��I�ING ADDRESS: '�3 ;,�� �c `��� crec U=
cz�: ��v�.t:., zzp: ss3�y
PHONE:
CvN'�RACZ'OR: ZIP:
CZTY:
��ZI�IG ADDRESS-
SmATE LSG.=NSE: _
PEONE:
��C3Z'I'ECT/�IGINEE�:
C=�: Z IP:
tu�.S.I.ING ADDRESS:
REGIS�'�SON �
x�:
riove
Addition Accessory S�iuLand�Alteration
R"�PE OF WpRK: New Renovzte
De�o R�*node�/Alteration _
- - .- �iv� �S � � _/c��C��.
P�OPOS�D WORK (describe in
detail) : �'�,nGLn' L'� "�
:�'��f ut�;'zL =3"''��� _
STORIES s �=--�_ S�- "y OF EgCH FLDOR: �-J � - `r _
2tii0_ OF BEDROOMS:
'�-� Gr'1R1�G� ST�iI.LS� ATm� DET. _
�T�C�Tp� CDNS�RIIC'I'TON �ALI7ATSON (eaclndin4 land 1 _ S �
R
,- an�]-y for a building per�it ae wo � �ri��i be in conf rmancef withttne
T he_eby _ - that th
Code; that T_
above is complete and accurate, and with the State Building e�it; and
crdinances and codes oi the City
understand this is not a permit and work is not to start without a p
that the work will be in accordance with the aPProved pl�s- _ - - '
� DATE: �( -- 7-- J4 —
APPZICANT'S SIGPIATU�=: - .
- •i;
` ` � �i��� �� ���N�
Post Office Box 66•Crystal BaY,Minne"'ota Sb323•Munidpal Offices
M '
� On the North Shore af L�e Mirusetonka '
• ' • •
DATA PRNACY ��SORY •
� "Rights of subjects of
Subd. 2. ermit or
In accordance with M.S. 13•ou'that your request for a P uire
data", we Would like to inform y o f its departments may req
of Orono or any �n=o�ation.
license from the City rivate or coniidential
you to furnish certain p
you are noti�ied that: -
e iniormation you furnish censebrequest a, aetermine your
1. Th e�i� or li
cualif-�a�=on for the p uire that
refuse to supply data, but refusal may req
2. You may the per�it or license.
tne City deny �
be snared with oth�r local , s�ate or
3. The information maY
rocess the permit ai
f ederal agencies to the extent necessary to P
?icense. , ac��o%
a If vour reques�ed pe="m1t °r Iicense r�elauc r�s Councii.
n=o� ma become p
to apgrove, some i ation Y
- have certain rights under M.S. 13.04 to review priva�e
�, You _
data on yourself.
6, your full name is required to proc�ss
this application or
per,nit.
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r^isst
Midd?e
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Address SS3�`i
O2U� N Z ip
State
City
�`72 � `�g�� .
Phone
I understand mY =ights as stated above.
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Signature
BUILDING&ZO`jiNC-4'73-7357 • ADMINISTRATiON&FIN�CE-;73-7358
� PUBLIC WORKS-473-7359
ASSESSING