HomeMy WebLinkAbout1995-006333 - add/remodel � � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ;_s'_;L.:�:=_�
Crystal Bay, Minnesota 55323 Permit Number: :" ^ _
(612)473-7357 Date Issued: ;:::�.:;-:��..�:-�,�
SITE ADDRESS:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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C�TY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: permit#:
ALL INFORMATION MUST BS SUBMITTED IN FDI�L BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
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THE APPLICANT IS: (circle one) 0�4NER r CONTRACTOR
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JOB SITE ADDR$SS: 9�p�� S�IOtOI�/w00c.Q � ZIP:
(work)�a$-_����1
NAML OF OWNER:�vl 1 � 1�J �P�'S� PHONE: (home) �i`� )—�1 ���
MATLING ADDRESS: ��o l (� S�i�l�W b�C.� �d CITY: (���a ZIP:
CONTRACTOR: �2� S���^,; (�;c P$orrE: �y 5 -�I � (�
IKAILING Annx�ss: a��1 l 1-t-er.� be��, L�. cITY: ("1,�^�-��� Z1r: SS3oS
STATE LICENSE: #
ARCHITECT/ENGINEER: p$��'
MAII,ING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSED WORR (describe in detail) : �' -�" ��n�i��- �c�J�P► �hS"'�"t�`�� ����"� —
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-F � � �,, � � o�,
STORIES:_�_ S4- F�T OF EACH FLOOR=
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRIICTION VALIIATION (egcludi.ng land) : $ ��- J �1�
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. �
APPLICANT'S SIGNATURE:y �( �� `-=�, �� - DATE:
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� RONo
CITY of O
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� _ � � Orc the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of sub eerc�ts� o��
data", we would like to inform you that your request for a P re uire
license f rom the City of Orono or any of its departments may Q
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish will 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 , s�ate or
f ederal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or 3.icense �equires Councii ac��on
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 required to process this application or
permit.
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First Middle La��
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Address `�
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City State Zip
SyS -�I6�
Phone
I understand my rights as stated above.
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Signature �
BUILDING&ZON(NG-473-7357 • ADMINISTFtATION&FINANCE-473-7358
• PUBLIC WORKS-473-7359
ASSESSING