HomeMy WebLinkAbout1992-004737 - re-roof overlay PE:. :$ �,°�IT
CITY OF ORONO '� PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 ������������
Permit Number: i�i��.7:;i
Crystal Bay, Minnesota 55323 Date Issued: 1 t7f��=�:''��'
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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C�?�V�RAC�TO�; — �F���t i c�i�t. — OWNER:
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APPUCANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF CRC270 - BJILDZ27G FER�ST A_PPLIG?TION
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Date Received : •
otal Fee: $
rid�� E'-�D?"O�i c�C :
n`orza R� PP,�;`� y ��3�
:yL INFOR'�TION MQST BE SIIBMIT�ED IN FIILI, BEFORE PI�N RL�7IEW WILL BE START�'l.D
(See Check-a=f List EncZosed) �
-----------------
�E p,FPI,�CANT IS: ( circle one) OSv'�IER or CO P.ACTOR
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'1B SITE ADDR.$SS: ��� t��G7��L(�DO�� � �C� ZIP: 5=� � ��
" (work)
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� � PHONE z (hcme)��� ��
=.ME OF OWN�R: c? C'%� L' � �C'i ,
�ZING ADDRESS: �� � .J�� �'` t'GU�r
CITY: l.��fJ'/� �J ZIP: .-�5 � ��
.�
� � 7
/ � � PH rrE: ��� ����� -
��c�cR: 7�J '
''� � �� CITY: "2�/ zIP: -��L� �
?'Z,ING ADDRESS: �7_Sc�� �
��� Lzc�s�: � I�DD-S��
PHONE-
.�32 TE CT�E:IGINEER:
CI�: ZIP:
'IZING A.DDR.ESS:
REGISTR�TION :`
,��:
� Addit�.on Accessory Structure riove
;�E OF WORK: Llew
- De.no R�*nodel/Alteraticn Renovate .I�and Alteration
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/ // �r' ��S
:OPOSED WORX (describe in detail) =r�!'�U � ,�"'PJ�s � Cl ��i'ltr.�r 4 -C, c-�---
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�`,i►n• �� " ci� �
:ORIES: SQ. FEET OF EAC3 FI.00R:
pg gEDROOMS: Gf�•RAGE STAZI.S: ATT. DE'=•
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-TIMP,TED CONSTRQCTION VALIIATSON (esciuding Z�d) = S �
nereby zDT7I�j for a building per.nit and I ac?�ncw�edge that the infor::�at-on
�ove is compl.ete and accurate; that the wor�C wil � be in conforinance with the
:3inances and codes of the City and with the S�ate Building Cede ; �'�at T
:3erstand this is not a permit and wor:c is not tc start without a per�nit; and
•.at the work wiZl. be in accordance with the aporoved plan.
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o/'�C ti:� DATE: d �
,_T,ICs'�NT' S SIG:7ATIIRE: � -
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�� Post Office Box 60•Crystal Bay, Minnesota 5a323•,�iunicipal O{nces
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. a - � g Orz the North Shore of Lake l�finnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. I3.04, Subd. 2 , "Rights of subjects of
data", we would Iike to inform you that your reguest for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or contidential. information.
You are notified that:
l. The iniorination you furnish will be used to determine your
auaiisication for the per•nit or Iicense recuested.
• 2. You r,tay refuse to supply Cata, but re=usal may require that
tne Citv denv the pe �� it or license.
' 3 . The intormation may be s:�ared with o��er ioca? , s���e or
� f ederal agencies to the ext�nt necessary to process tne pe�-mit or
?icense.
a. If your requested per:::it or Iicense =ecuires Councii ac�_or_
to aDDrove, some inior.^.tation may become pu�?ic.
� . You have cer�ain rignts under M.S. 1� . C4 to rev_zw gr=-rate
data on yourself.
. 6. Your ful.I. name is required to proc�ss th�s appl.ication or
pe*:nit.
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Cit State Zip
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• I understand my rights as stated above.
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� Signa ure . � �
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1LDIVG& ZONI`G - 473-7357 • ;�D.ti11NISTRAT10N& FNANCE - 473-73:3 • PUBLIC tivqRhS --t73-73�9 i
ASSESSlY G