HomeMy WebLinkAbout1993-005619 - reroof ,, .� PERMIT L--�_
CITY OF ORONO PERMIT YPE:
2750 Kelley Parkway • P.O. Box 815 Permit Num er: �'�i�'--��'��`
Orono, Minnesota 55356-0815 �'''�-'_' �
(612) 473-7357 Date Issued: � 4��� c�.�::;
SITE ADDRESS:
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE /LL'�
/��'-/
` ' CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ 'Y-J� �� Date Received:
Date Approved:
Entered By: l'1✓ s, �� � c✓
Pel�ntit r.
AT•T• INFORMATION MIIST BE SIIBMITTED IN FDLL BEFORE PLAN RES7IEW WILL B$ STARTED
(See Chec}c-aff List Enclosed)
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------------------------------------ -
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TgE APPLICANT IS: (circle one) Oi+TNER or CONTRACTOR�
JOB SITE ADDKRSS: � y �� 5h«�`�u%���� ��� ZIP'
(work)
�� PHONE: (home) � 7/-7� �"7
N� OF OWNER: ///�i r ��� �-f'cL-c.?�-1 +-L
i
MAILING ADDR.ESS: l �'I 7� S�ia.4,. u,�c��2.� CITY: �l�'��i?.Q IG�/"'i'�%f�ZIP:
CONTRACTOR:�_� ��f'1 S�iPL �� - PHONE: �� 3 - 3�� �
,
7�71T1�p �+ ^ 7 / � c cz�: i�p -; ���i1 zzP: .-'3�
MAII�ING []i/LS�i+SJ� /��- / �' �1• n ��T11 �—
STATE LICENSE: � 3 9�G �
���3�' _ 3�3
ARCHITECT/ENGINEER: ��2 L2-C.� � ,�� �� PHONE: �I j�?,- 7l.�`�
MAILING ADDR.ESS: CITY: ZIP:
NAME: R.EGISTRATION n
TYPE OF WORR: New Additian Accessory Structure Move
Demo Remodel/Alteration Renovate Z,and Alteration
PROPOSED WORR (describe in detail) : �-�: �Zc G7� f`t-� �a-�� � " ' "� �
�
STORIES:�_ SQ• FEET OF EACH FLOOR: /Z
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ � g �7 l . �-`�-
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 wi�ha�hl
ordinances and codes of the City and with the State Building Code;
understand this is not a permit and work is not to start without a permit; and
that the work will be in accordance wit,�,i the approved plan.
� ,.� ,���
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APPLICANT'S SIGNATURE: `��� (2��- � _ DATE: C�
4- �
` RONO
CITY of O
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� _ � � 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 would 3ike 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 f t or li ensebreque tea, determine your
qualification for the perm
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
federaI. 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 priva�e
data on yourself.
6. Your full name is required to procsss this application or
permit.
First
Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature � �
BUILDiNG&ZONING—473-7357
• ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING