HomeMy WebLinkAbout1994-006239 - reroof PERMIT �
� ��Y OF ORONO PERMIT TYPE:
':2750 Kelley Parkway • P.O. Box 815 Permit Number: �;_;:i {�;i��;;
Orono, Minnesota 55356-0815 Date Issued: �
(612) 473-7357 �=it 3�_�'�:���_-�
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APPUCANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �,�� �
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CITY OF ORONO - BIIILDING PER'�iIT APPI,IC�T�ON
� Dat� Received:
Total Fee: $ -
Date A��roved: �
Entered Bv: �� — Per_nit� �' � �% - _-- -
TION MIIST BS SIIBMITTF.D IN FUZ�L BEFORE PLAN RE�7IEW WII�+ BE Sg�RTED
�L ���� (Ses Check-off List Encl.osed)
TgE APPI,ICANT IS:--(cyrcle one ) -_Oj`r`jER ar CONT��CTOR
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JOB SITE ADDRSSS: �� C`" I
(work)
� �`j(, � . (�� (�{,� PHONE: (home)���� �
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x� oF owx�: �% �S 3�i
� � �' �} �� �` f�.1�� CITY: Cv���� ZIP:
MATZING A.DDRESS: � ��� S <<Cc- t� —
� PHONE:
CON�CTOR- _
CITY: ZIP:
MAT_T ING ADDRESS_ .'
STATE LIG."NSE: T
PHONE:
ARCHZTECT/�NGINEER:
CSTY: ZIP-
MATI�ING ADDRESS-
REGISZ'RATION 4
NAME:
Move �
New Addition Accessory St`uLandeAlteration
TypE OF W�RK- Renovate —
D�o Re.*nodei/Alteration�_
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C,�n� �=� � ,
P?ZOPOS� WORR (describe in detail) % l� _
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STORSESs I;�� S4• �T aF EACH FLDOR:
G�g�G� STA7.T,g: ATT.�,_ DET.
NO_ OF BEDROOMS: � _ `'�:r
, I �
ESTSMA�F� CANSTRIICTION VALIIATIO
N (e.aclnding Iand) : $ � ���
ermit and I acknowl.enge that the information
I hereby app I.y f or a bui lding p that I
ove is complete and accurate; that the work will be in conformaCn de;n7zth t e
ab and with the State Building e�it; and
osdinances and codes of the City
understand this is not a permit and work is not to start without a P
that the worlc will be ia accordance with the approved plau- _ . —'
_ /.•
__! '. '� �` rL
_� _------- DATE. ,
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APPI,ZC�NT'S SSGNATQRE�— .
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� . post Office Box 68•CrYstal Bay, Minaesota 5a323•Municipal Offices
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On the North Shore o�Lake Minnetorz a
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DATA PRI��� ��SORY
� Subd. 2, "Rights of subjects oi
=n accordance with M.S• Z3'ou�that your request for a per�it or
we woul.d like �o inform y oL its departments may require
�=�`a�' oz Orono or any
:L�.cense from the City
vou to furnisn certain private or confidential inrormat�.on.
you are noti�ied that:
i be used to determi.ze your
1. Tho information you furnish wii�
cualificatien for the per.ni� or license recuested•
2y ouu �ay retuse to supply
data, but resusal may require that
-r-*�it or license.
the City deny the pe-��•
; n_ormation may be snared w�th ot:�e=' local , s�a�e or
3 . The r o to process t'tie perni.� oi
federa.l agencies to the extent nec�ssary
�icznse. •
yod pennit or iicense reQuir=s Counc�.i ac��or
�, your reques�_ , become pupZic.
to aperove, some intorma��on may
You have certain rights under M.S. 13.Oa to review �riva�e
data on yourself.
6 . Your fu?1 name is recuired to process this applicat=or. or
pernit.
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I understand my rights as stated above.
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Signature - �- .
=UILD[NG&ZONING-473-7357 • ADMINISTRATION&FINANCE-�73'�358
� PUBLIC WORKS-473-7359
ASSESSING