HomeMy WebLinkAbout1994-006298 - repair basement PERMIT � /
CITY OF ORONO ,� PERMIT TYPE: v _
2750 Kelley Parkway • P.O. Box 815 � � r Permit Number: `="'`��7��'���
Orono, Minnesota 55356-0815 �_'��'-''�'�''`
(612) 473-7357 Date Issued: _�;:,��}�.�r:,��
SITE ADDRESS:
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CONTRACTOR: OWNER: — �����1 ?�ri��E�� —
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APPLICANT-PERMIT SIGNATURE ISSUED BY:SIGNATUFE
CITY OF ORO�?O - BIIIZDING PERMIT APPLIC�TION
. * �
� Dat� Received:
Total Fee: S -
Date A�proved: �
Entered Bv: ��� Permit�: �' ����. - -__
�.
TION MIIST BS SUBMITTED rN FUL.Z BEFORE PI+AN RE�7IEW W�LL B$. SgARTF.l]
pT.T. INP�RMA (See Check-off List Enclosed)
Tgg p,pPLICANT I5: (circle one) O�dNER or CONT.RACTOR
ZIP: 5�3'3 f �
Jos sz� x�D�zsss: /�� o�/���.lirv� 3���v o o ��
G � / � �- � 3 (work) _
OWNER: 6���/ � �u�`l'll� PSONE: (home)1�77 8`3f�`�
g�ME OF Gy)/� ZIP: 5--5^3 !�
MATZ,ING ADDRESS: ;�300 �l�e�°��•v� �ki�� cz�: O�
PHONE-
CONTR�CTOR: � ^
��: ZIP:
MATT IBTG ADDRESS:
sT�� zzc�sE: �
PHONE:
ARCHITECT/ENGINEF.Rz
C=�: Z IP:
MATI,ING ADDRESS:
REGSSTRATION a
NAME:
Accessory Structure Move �_
�E �g j.7ORg: New Addition Land Alteration
Re.*nodei/Alterat' on � Renovate
D�o � ���A�i� _ —
PROPOSF.D WORK (describe in detail) s � � � ��e����-
. SQ. gEET OF EACH FZOOR: �c OD C�
STORSES'�._
NO. OF BEDROOMS:�
G?,gAGE S'rAT•T,S: ATT. Z DET.
SON VALI7ATION (eacludin�J laad 1 : $ �`�� �-
EST3MATED CONSTRIICT
ermit and I ac?cnowledge that the information
I hereby apply for a building Pthat the work will be in conformaace w thathi
above is complete and accurate; Code;
ordinances and codes of the City and with the State Buildiag e�it; aad
understand this is ne ia accordance ith the approved pIa„a ithout a p
that the work will b , .
DATE:
APPLIC�N'P'S SSGN�+iTORE=
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� ����' o� ���N�
Post Office Box 6&•Crystal Bay,Mi.nnesota 5�323•Munidpal Offices
M .
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On the North Shore of Lake Minneto a
• ' • •
DATA PRNACY A��S�RY
Subd. 2, "Rights of subjects of
In accordance with M.S. 13•ou�that your request for a permit or
we would like to inf orm Y of its departments may require
data", o= Orono or any
license from the City
you to furnish certain private or confidential information.
You are notified that:
l, The information you fur or li ensebrequested, Qetermine yaur
qualification for the permit
2. You may refuse to SL1DpI-Y
data, but refusal may require that
tne City deny the permit or license.
3, The information may be snared W'-tht�°P=oc sscthe pe=mit °r
f ederal agencies to the extent necessary
?icense.
our requested permit or Iicense requires Councii ac�tor.
q, If y become public.
to aporove, some information maY
5. You have certain rights under M.S. 13.Oa to review private
data on yourself.
6, Your full name is required to proc�ss this application or
pe�it.
�B B�"Q � �/� � �-- /�c��-t��� ,
Middle Last
First
� � a o �����2�����C p �� �
Address G'y( �s 3 a1
/`�/Y 0 � Z i.p
City
State
�T3-�3 �` .
Phone
I understand my rights as stated abOVe•
r� .
ignature �
- • PUBLIC WORKS—473-7359
BUILD[NG&ZONING—473-7357 • ADMINISTRATIOtY&FINANCE—;�3'�358
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