HomeMy WebLinkAbout1991-004077 - change exstg bath PERMIT
C;TY� QF ORONO PERMIT TYPE: �,t�IL�tI�vG
1335 Brown Rd. South • P.O. Box 66 Permit Number: t-y�r4'-':% °°a
Crystal Bay, Minnesota 55323 Date Issued: � � �=�%=�1
(612) 473-7�57
SITE ADDRESS:
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REMARKS:
FEE SUMMARY: �
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APPLI ANT PERMITEE SIGNATURE ` ISSUED BY:SIGNATURE
1 ` CITY OF ORONO - BIII7�DING PERMIT APPLICATION
Total� Fee� $ ��• ! � Date Received: �l - a S' 9 �
uai8 isYviu'v�u:
Entered By: - permit#: 7��1
AT•T. INFORMATION MIIST BE SDBMITTED IN FOLL BEFORE PLAN REVIg'W ieiILL BE STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
T� APPLICANT IS: (circle one) OWNER or CONTRACTnR
JOB SITS ADDRESS: /�.�� �Ap� l�,�C�l� 1JYC ZIP: �jS� I
(work)
NAl� OF OWNER: �l�$ '� l._.� '���t'C� PHONE: (home�7����
MAILING ADDRESS: ��j ���1��Q��ilf�l�fl �Jl� CITY:�`Q�l�Pt�C� Z IP: '�j �J J� I
CONTRACTOR:�1 E�� �$b Q�4°�n l�. .t�1.l�G•���D'�'(�/�� PHONE:���-���3
MAILING ADDRESS: I���� ��-��,Q • CITY:/������{� ZIP:
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remo�ce�/Alteration_� Renovate Land Alteration
PROPOSED WORR (describe in detail) : I/l�S�/�i�L(r �� �U�Z�� Z� vL►�S� ��C�1
�1.��o _ �' l� �
� lll9[701�? IOV �L� �-�- � �S�t�R-Y
STORIES: � SQ. FEET OF EACH FLOOR:
NO. OF BSDROOMS: GARAGE STALLS: ATT. DET.
$STIMATSD CONSTRDCTION VALIIATION (escluding land) : $
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I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the wark 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 SIGNATORE: � DATE: I,���` G �
(� 1� �{-z, L�s ��...�
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� �i�T�O� �RONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� - e • 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 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 confidentia]. information.
You are notified that:
1. The information you furnish will be used to determine your
qualification for the permit or license requested.
2. You may refuse to suppl.y data, but refusal may require that
the City deny the permit or license.
3. The information may be shared with other local, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council action
to approve, some information may become public.
5. You have certain rights under M:S. 13.04 to review priva��
data on yourself.
6. Your full name is required to process this application or �
_ permit.
`� N� �
F rst Middle Last
��� ���t� � 1�7 _
Address
��� �ti� . �`� �(o�
City State Zip
��Z -� � ��
Phone
I understand my rights as stated above.
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION Fc FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING
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s�.Q4 xica�rs oF sus��'s aF �aja
Subdivision L T�ipe of ��- The rights af individuels on whom the data is
stored or to be stored shall be as set forth in this section.
gubd, Z, information required to be g��� �����' An.individuel asked to
- ' su 1 rivate or confidentiel data concerning �mWit�h�in� collect ng stat gency,
PP Y P
purpose and intended use of the req em;d �b�whether he ma� refuse or is legally
political subdivision, or statewide sys ' �own consequence arising from his
required to supply the requested date; (c) any . �d (d) the identity of
supplying or refusing to supply private or confidentiel data,
other penons or entities suthorized by state��e�ke�to s pplyein est gat ve da a
requirement shall not apply when en individu
pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mg lert tgX re�und u�structio�nste8dh�s
subdivision in the individuel income tax or r•
on those orms. . - -- - - .
Subd. 3.
Access tc data by i����' �p°n request to a responsible
euthority, an individuel shall be informed�he bliC hPrrvateeor confidential.e IIpon his
individusls; and whether it is classified p � ublic data on
further request, an inciividuel wbo is the subject of e to himrland, if he desires, shall
individuals s1�all be Sh°wn the ciata witho of�hat data• After an inciividual has been
�e informed of the content and meaning t� �� need not be disclosed to
shown the private data end informed of its u�e�BBC�on pu��t to this section is
him for six months thereafter unless e �SP
� ending or additional dats on the individu e h� ateeor Publi�datgruP�nar quest by
' P require the
responsible authority shall provide copies o t p
the individual subject of the dara•
The responsible����f°nit3'�a compiling the
requesting person to pay the actusl costs of making, YI g�
copies. ` immediatelY, if pessible, with any request
The responsibls authority shell comply of the date of the request,
made pursuant to this subdivision, or within five �,�immediate compliance is not
and le holideys,
excluding Saturdays, Sundays �
ossible. If he cannot comply with the request within that time, he shall so inform the
p hsve an additional fi�e daYS within which to comply with the
individual, and maY �d le al holidays•
request, exeluding Saturdays, Sur►daYS g
Subd. 4. Procedia'e when data is net acc�ate or complete. An indi�id�a� m8y
himself. To
contest the accuracy or comQleteness�of public o lnri�� the�responsible authority
exercise this right, an individu8l s� notify �ible authority shall within 30
describing the nature of the disagreement. The resPo
days either: (a? correct the data found to be inae�i8e��u�gpeec pienLs namedtby
notify past recipients of inaccurate or mcomp
the individuel; or {b) notify the individual that he believes the dat8 to �ement is
Data in dispute shall be disclosed only if the individual s statement of disagr
• included with the disclosed data. � appe�led pursuant to the
' The determination of the responsible authority to contested cases.
provisions of the administrative procedure act relating