HomeMy WebLinkAbout1994-006572 - reroof/tearoff � PERMIT
��' � CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 =����;_ �;' `�v�.=
Crystal Bay, Minnesota 55323 Permit Number: ;:;;_;:_,. .
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(612)473-7357 Date Issued: ; :; f�_:_;:.,.�:��r
SITE ADDRESS:
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CONTRACTOR: OWNER: -- F`�°�°���� � = =��.�- —
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE 'C�•
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� ' CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ Date Received: _
Date Approved:
Entered By: ,��'I • u. � ,�,,
P e rm i t,r. �'%°`�; ✓°
ALL INFORMATION MIIST BS SIIBMITTED IN FIILL BEFORE PI,AN RE�7IEW WILL BE STARTED
(See Check-off List Enclosed)
--------------------------
THE APPLICANT IS: (circle one) �'OG�1NE$ �or CONTRACTOR
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JOB SITE ADDR$SS: d� ��
(work)
N� oF owrrEx: '�Cc'6',;�'4r� ��r {%,�✓ PHorrE: (h ome) `��/,< `:`� �
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CONTRACTOR: PH��
MAILING ADDR.ESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: pH��'
MAILING ADDRESS: CITY: ZIP:
N�: REGISTRATION tt
TYPE OF WORR: New Addition Accessory Structure riove
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSED WORR (describe in detail) : �`'�P - S��r� �' �' � `��'�
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STORIES: �-� SQ. FEET OF EACH FLOOR%
NO. OF BEDROOMS:� G�GE STALLS: ATT. DET. x
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ESTIMATED CONSTRIICTION VALIIATION (ezcluding Iand) : $ "�S �C/
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 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.
� ATURE� lG� �/� � � DATE: �C^ :�� �
APPLICANT S SIGN %`
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�� � � Post Office Box 66•Crystal Bay,Minnesota 55323•Mu��P� ���
•
� _ e � On the North Shore of Lake Minnetonka
DATA PRSVACY 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 confidentia3 information.
You are notified that:
1. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
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 , e�i� or
federal agencies to the extent necessary to process the p
3icense.
4. If your requested permit or be ome e ub�ic res Councii ac��or.
to approve, some information may P
5. 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 applicatior. or
permit.
�,�.t-�//�'�i� �/'S7��'r �)��-`i��
First
Middle Last
,��� �� -S`'�L<� ��,�.�;c� :���c�'�
Address
l,�,l �;� �%l�t,� �-�.���
City � � State Zip
�/�;� ,� . �/ �
Phone
I understand my rights as stated above.
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Signature
BUILDI\G& ZO�iING—473-7357 • ADbfINISTRATION&FINANCE —473-7358
• PUBL[C WORKS —473-7359
ASSESSIN G