HomeMy WebLinkAbout1994-006662 - reroof PERMIT
� CiTY OF ORONO
PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 c:`:.�i`..;.:.!�:�i`;
Crystal Bay, Minnesota 55323 Permit Number: ;_�:rt�„-,�-,;�
(612)473-7357 Date Issued: � � ,�;�° �i�-�.
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: --� -- �
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FEE SUMMARY:
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APPLICANT%PER ITEE IGNATURE ISSUED BY:SIGNATURE
. _ . CITY OF ORONO - BIIILDING PERMIT APPI,ICATION
��, � �% Date Received:
Totai Fee: $
Date Approved :
Entered By: �� �=%� � permittt:�' � �� �--
AT.T• INFORMATION MIIST BS SIIBMITTED IN FffLL BEFORE PLAN REVIEW WILI' BE STARTED
(See Check-off List Enclosed)
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THE APpLICANT IS: ( circie one) �OPTNER or CONTR.ACTOR
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ADDRSSS: .��� f � `'_�F�.,- � � � ���� c� I'� ����� ��� ZIP: '_,'> J �1 �
JOB SITE �
(work)
� � PHONE: (h ome) `/ t/ J ��
NAME O F O.WNER: i �_ t � � , v�' �� � �l
j '1 �� CITY: \�� �_��, :_��, t�t f� ZIP: °>`��_�ct /
MAILING ADDRESS: r �`-{ l ��b�,A l�� i.• : t'L ��.� � �
, ;� PHONEs
CONTRACTOR: � "
MAILING ADDRESS:
CITY: ZIP:
STATE LICENSE: �
PHONE:
ARCHITECT/ENGINEER:
MAILING ADDRESS:
CITY: ZIP:
N�_ REGISTRATION R
TYPE OF WORR: New Addition Accessory Structure
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Demo Remodel/Alteration Renovate .,_, Land Alteration
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PROPOSED WORR (describe in detail) : '" � r � "�
STORIES:�,_ S4. F�T OF EACH FLOOR: ; r;.r '
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. , �- r �:_
ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ � :;: <
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 `^'1thathI
ordi.nances and codes of the City and with the State Building Coe��it; and
understand this is not a permit and work is not to start without a p
that the work wil 1 be in accordance with the approved plan.
�� DATE: / . ._ � .z �r � ��,,�,
APPLICANT'S SIGNATURE: - ,� .;_ . ' % , � < �. _;_ , '
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��� ' CI�`Y o� ORONO
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Post Office Box 66•Crystal Bay, Minnesota 55323•Municipai Offices
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� _ e � On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data" , we would Iike to inform you that your request for a permit or
license f rom the City of �ate or conf dential e nf rmationmay require
you to furnish certain pr
You are notified that:
l. The information you furnish will be used to determine your
qualification for the permit or license 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 oth��r e scthe permit or
federal agencies to the extent necessary to p
license.
4, If your requested permit or Iicense requires Councii ac��or.
to approve, some information may become public.
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 application or
permit.
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First
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Address
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City� State Zip
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Phone
I understand my rights as stated above.
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Sig ature . �
BUILDIYG&ZONING—473-7357
• ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS—473-7359
ASSESSING