HomeMy WebLinkAbout1991-003587 - replace pylon sign . PERMIT !
� - G!T�'�t71F �RONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: ���I�itu �
Crystal Bay, Minnesota 55323 Date lssued: ;����='=��=�:'
(612) 473-7357 t�:=:i 1�i'`�:i
SITE ADDRESS:
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CONTRACTOR: OWNER:
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:PPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
_ �
� � ' . CITY OF ORONO - BIIILDING PERMIT APPLICATION
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� Total Fee: $ �� " Date Received: ,j- �
! ;� Date Approved: 3--� �Z-- -�j/
Entered .By: � �.
�� P e rmi t#:��j.����
ALL INFORMATION MUST BE SIIBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
---------------------------------/-�'�`� -------------------------------------
THE APPLICANT IS: (circle one) ` OWNER br CONTRACTOR
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JOB SITE ADDRESS: �3�5 � V�/�n�.�,.> ��; a �� ZIP: j � 3 �' Z_
(work) �!�1-��157
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NAML OF OWNER: T f'��l�s,.� � Sv �,��,,�.�- �:�.,ti, , c_1 i PHONE: (home) y'12- 5'�D`I
MAILING ADDRESS: �c� 3L /�{,�W�-�•� d t��-� ��1 CITY: y�'1 0� �� �L ZIP: � 5 3 �`�
CONTRACTOR: �7-r�-"f+�%A S� 5 .✓ PHONE: g 3 3 - ^7"7 3 D
MAILING ADDRESS: � '�lza �,.i. �,a�'c. CITY:S�-- L�•��s !tirc ZIP•
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
�21 � �d�Pz�
PROPOSED WORR (describe in detail) : J�k pF�« ,-�,,, c X�s��N���� 6•✓, ..�iTh ,� ,�c�..�
�i2/� �..l�,,,A.,..�� �� L--r✓, NC.,✓ C�e�.� �� r3t ZZ. tT t�'c,,n G2o.�,,..c�. � � ' �i+/�.Co,�n C,u� L�NE
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAG$ STALLS: ATT. DET.
ESTIMATED CONSTROCTION VALIIATION (excluding land) : $ ;.--� / C=� Lf� �' �
I hereby apply for a building permit and I acknowledge that the informatic
above is complete and accurate; that the work will be in conformance with t2�
ordinances and codes of the City and with the State Building Code; that
understand this is not a �ermit and work is not to start without a permit; ar.
that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATIIRE: <�1✓�`-/r '�,�1-�J.� DATE: ��7 �7 /
(Please fill out the reverse side of this form)
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� CITY of ORONU
Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices
!
o _ � � On the North Shore of Lake Minnetonka
D�1�A �R�YACY ADV�' SQRY
In accordance with M.S. 15.165, "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 confidential information.
You are notified that:
1. 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 other local , state or
federal agencies to the extent necessary to process the permit or
license. , -
4. If your requested permit or license requires �Council action
to approve, some information may become public. f'
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permit.
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First Middle Last
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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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Signature
BUILDtNG&ZONING—473-7357 • ADMIIVISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING