HomeMy WebLinkAbout1994-006101 - add/remodel -
PERMIT
t � CITY OF ORONO PERMIT TYPE:
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2750 Kelley Parkway • P.O. Box 815 Permit Number: 4;��l�y�;,���'� '
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: �;��i;.-,i�f'��
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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APPLICANT/PERMITEE SIG URE ISSUED BY:SIGNATURE
, - , CITY OF pRONO - BQILDING PERMIT APPLICATION
� Date Received:
Total Fee: $ -
Date A��rove�: �
Entered By: PermitQ: _ �
AT.T. IPTpORMP,TION MIIST BS SiTBMITTED Il`t FLnZ BEFORE PLAN REVIEW WIIS BS ST`BRTI�D
(See Check-off List Enclosed) ____
----------------------------------OS�INER a
. ONTRACTOR.__..-�
T� APPLICANT I5: (czrcle one) .�._... _` _......
� � ZIP:
JOB SITE ADDRBSS:
� (work)
� / ` pgpNE: (home)
g�.ME OF OWNP•R: L>� / / S/M �- .
CITY: ZIP:
MATZ�ING ADDRESS:
� ��r�r-e, mc� 2 . PHONE: �' !I �`
CONTRAC'SOR:
�, n ci�: f��� ziP: �'.:310�/
1KATI.ING ADDRESS: � � Ov� �
sTATE LICENSE: � �-/y�� —
� PHONE:
ARCHITECT/ENGINEER%
��: ZIP:
MATI�ING ADDRESS:
REGISTRATION u
NAME:
Accessory Structure Move �
Z•ypg pg WpgR; New Addition Land Alteration_,_
Demo Remodel/Alteration Renovate
PROPOSF.D WORR (describe in detail) :
STORIES: SQ. FEST OF EACH FLOOR:
NO. OF BEDROOMS:
G�gp,Gg gT�LI�S: ATT. DET.
g,STI�� CONSTRIICTION VALIIATION (eaclnding land) : $ ���� �—
I for a building permit and I acknowledge that the information
I hereby app y that I
above is ccmplete and accurate; that the work will be in conformaCn�cdewith t e
ordinances and codes of the City and with the State Buildinq e�it; and
understand this is not a permit and work is notr ov stpi�ithout a p
that the work wiZ 1 be in accordance with the app . _ •
�: � 2_ — 9�
APPZ�ICANT'S SIGNATDRE:
_ �
� (��'��" o� O�t�I�TO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
• _ � � Orc the North Shore of Lake Minnetonka _
DATA PRSVACY ADVISORY
In accordance with M form3•ou�that your request for a perm t or
data", we would like to in y o f its departments may require
license from the City of Orono or any
you to furnish certain private or confidential information.
You are notified that:
l. The informati�heY e�t or li ensebreque tea. determine your
crua1ification for P
2. You may refuse to supply data, but refusal may require that
the City deny the perntit or license.
3. The inf ormat��o the extenthnecessary to processcthe permit or
federal agencies
?icense.
4. If your requested permit�ar become p blic.res Councii ac��or.
to approve, some information y
7. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required to proc�ss this application or
pennit.
2�c��/�'
� � Last
First
Middle �
S�' �i S�— „���_—s �"' �
T
Address .
� � �
a v rJ
City State Zip
7/- S/.��
Phone
I understand my rights as st ed above.
ignature � � �
BUILD[NG&ZONiNG—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
pSSESSING