HomeMy WebLinkAbout1992-004524 - add/remodel . � PERMIT
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: �t ir�,���.���
Crystal Bay, Minnesota 55323 Date Issued: i y7 f��/�=�g
(612) 473-7357
SITE ADDRESS:
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F'. I .N. � i 7-117—�':_:—:�f—��i i i�
DESCRIPTION:
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FEE SUMMARY: ` � `` ^ q�;i�f��
VAL4IG�T T f_:i�,i �7,�ii�t 3
E;�SC F�� $'�'�_C)i i
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CONTRACTOR: — A����1 i c�nt. — OWNER:
W I PJDi=+k1'=� M I�,F;�a��i'�, �� �'fi i�E 14717ii}:: F::I ELLEY ���ih!
1.1i�i �=:H►ihEL I NE DF� 1�7�� '=:H�DYW+j��� F�D
NA'JAFiRE Ff(V 5�:ti'�� WA`I�ATA MN ��:���1
c:�I'?:� 471-7��ir;� 4i1-7iyr.4
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
` � •• CITY OF ORONO - BUILDI�IG PER1tiSIT APPZ,ICATION
Total Fee: $ / C � f ; Date Received:
�� Date Approved:
Entered By: i ,' � �� ���
Permit tt:
ALL INFORMATION MIIST BE SIIBMITTED IN FULL BEFORE PI,AN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
-----------------------------
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THE APPI,ICANT IS: (circle one) OWNER o ONTRACTO
JOB SITE ADDRSSS:'��d [�/��/_�%�� � ZIP: 5����
(work) -- �
NAML OF OWNER: /P/% PHONE: (home) ��`����D(D`�
MAILING ADDRESS: � D �/7G �� CITY:�/�j►13 ZIP:�J` �
i.ONTRI�CTOR: �/l�I�S /�/��TS `�lh?D"hi PHONE: �rl��/n?�l)
MAII�ING ADDRESS: ,j�7�a C�i��l�"/� �/� CITY: �/Q-�Q T/� ZIP: ��J�!�
STATE LI CENSE: � �DO �7 6�
ARCHITECT/ENGINEER: PH��'
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION n
TYPE OF WORR: New Addition Accessory S ructure Move
Demo Remodel/Alteration Renovate Land Alteration
�� / ,�
PROPOSED WORR (describe in detail) : (�J/e �5�1
STORIES: SQ. FEET OF EACH FI+OOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
G�U
ESTIMATED CONSTRIICTION VALIIATION (ezcluding Iand) : $�`/ �� ✓
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 ac dan wi the approved plan. •
APPLZCANT'S SIGNATDRE: �''- �, , / - DATE:�� 7�Z
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CI'�Y of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� . � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we wauld like 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 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 local, s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii action
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 na�e is required to process this application or
permit.
�
First Middle Last
y 3�a ���- ,n� ,D�
Address
ti ,��I s.�39/ -
City State Z1p
�7'/- ldo�
Phone
I underst nd my i hts as a ed above.
Signature • .
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING