HomeMy WebLinkAbout1993-005118 - sash replacement f
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CITY OF ORONO PE�RMIT TYPE: �,ij���f��{�
2750 Keliey Parkway • P.O. Box 815 Permit Number: i�C;�� 1;==
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: i�_/���./°�:�;
SITE ADDRESS:
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CONTRACTOR: — t���F°1 1 C ct)l'�• — OWNER:
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APPLICANT/PERMITEE SIGNATURE • ISSUED BY:SIGNATURE -�-`�
� CITY OF ORONO - BUIZDING PERMIT APPLICATION
Total Fee: $ � �4�. `�5 _ Date Received:
Date Approved:
Entered By: i�'�� '` Permittt: _�i/J'
AT•T• INFORMATION MIIST BS SIIBMITTED IN FIILL BEFORE PLAN REVIETd WILL B$ STARTED
(See Check-off List Encl.osed)
-------------------------------------------
THE APPLICANT IS: (circle one) 0�+7NER or CONTRACTOR
JOB SITE ADDRRSS: ��V� ��'�C�.\\`''�k O�\v� ZIP:
(work)
NAME OF OWNEF2: �--���� �G�� PHONE: (home)
2 v � �� � CITY: ��l��1 ZIP: ����,\
MATLING ADDRESS: � "JO� S���V��.\ �� � -
CONTRACTOR: ��.i\��� \. '����`"� ! S� PHONE: r��v� �"�aV�
c� �. ���" ZIP: �����V
MAILING ADDRESS: �x��� �-. �� �� CITY:��
STATE LICENSE: � OO��i�
ARCHITECT/ENGINEER: PHONE:
MAIZING ADDR.ESS: CITY: ZIP:
NAME: R.EGISTRATION �
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : JJ��
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STORIES: SQ. FEET OF EACH FLOOR=
NO. OF BEDROOMS: GARAGE ST�LS: ATT. DET.
- Q�1 �1 ��
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl - $ �� \v�� �
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 T_
understand this is not a permit and work is not to start without a permit; and
that the work wiI 1 be in accordance with the approved plan. •
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APPLICANT'S SIGNATURE: ��a_1����C;�y:�'w'�,� � DATE: �� �����_.-.
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CI7�Y of OR�N
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal 4ffices
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� _ � � On the Nflrth Shore of Lake Minnetonka
. DATA PRNACY 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 f rom the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
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 other local, s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Councii actior.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to proc�ss this application or
permit.
����,. �o.�\ �,,��.�.�� _
First Middle Last
c`�.�\�. L. `�.��" S�
Address
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City State Zip
����w���
Phone
I understand my rights as stated above.
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Signature •
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—�173-7358 • PUBLIC WORKS—473-7359
ASSESSING