HomeMy WebLinkAbout1994-006602 - re-roof PERMIT
C:ITY OF ORONO PERMIT TYPE:
��50�C�Iley Parkway- P.O. Box 66 `:�:�:_L'±��;�
(;rystal Bay, Minnesota 55323 Permit Number: {:;i:;;.�-,__._:.
(612) 473-7357 Date Issued: � ? .�<:�::;. ;+�=,;:.
SITE ADDRESS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: - F:��=��- ���.=����=- --
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� AP LICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BIIII.DING PERMIT APPLICATION
1 � , Date Received:
Tota1. Fee: $
Date Approved:
Entered By: permit�:
ALL INFORMATION MIIST BS SiTBMITTED IN FIILL BEFORE PLAN REVIEW WII'I' B$ STAR�D
(See Check-off List Enclosed)
-------------------
THE APPLICANT IS: (circle one) 0��7NER or CONTRACTOR �
JOB SITE ADDR$SS: S �5 S S Q roc..�r� ��. zzp: SS3��
(work) ga� -��
N� oF owxEx: P 2.�e C' J �� l� PaorrE: (home) `-�1S-�13y �
MAILING �n�ss: S �S � S , (3�o,.�n � cz�:�a��za'�-� G�p: SS3 S�
PHONE:
C�NTRACTORt
IKAI G ADDRESS: CITY: ZIP: -
�
STATE LICENSE: #
ARCHITECT/ENGINE pH���
MAILZN DRESS: CITY: _ ZI�:
R.EGISTRATION �
TYPE OF WORR: NeW�i Alterationn Renovatery StruLandeAlteratione
Demo Remod /
PROPOSED WORR (describe in detail) : '(�e� ���� ��
�o� S�
STORIES: SQ. FEET OF EACH FI�ODR=
NO. OF BEDROOMS: GA.RAGE STALLS: ATT. DET.
_ —��- 3 �ao
ESTIMATED CONSTRIICTION VALIIATION (excluding Iand) . $�g'
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 perm ' and work is not to start without a permit; and
that the work wil 1 be in acco anc w' the approved plan. �
APPL
ICANT'S SIGNATURE: � DATEs ���� / �
` ' 3
� OliONO
CITY of
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offic�
•
� _ � � On the IVorth Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would like to inform you that your request for a permit or
license f rom the City o r�ate r confident al e nfornnationmay require
you to furnish certain p
You are notified that:
1. '1'he iniormati�a you furzish wi3_1 be used to determine your
qualification for the permit or license 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 oth=�r e scthe perm�t or
federal agencies to the extent necessary to p
license.
4. If your requested permit or license requires Councii actior.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself. .
6. Your full name is reguired to proc�ss this application or
permit.
Pe�e t- So�+r� �-��� \1
First
Middle Last
S , S � � C 0.,,�r1 � �
Address
� a�.Za�a- Mr� SS�
City State Z1p
��l S-q3�{ �
Phone
I underst my r h as stated above.
Signature �
BUILDING&ZON[NG-473-7357 • ADMINISTRATION&FINANCE-473-7358
• PUBLIC WORKS-473-7359
ASSESSING