HomeMy WebLinkAbout1992-004264 - temp sign �,,� �ERMIT
� ���� OF ORONO PERMIT TYPE: -
1335 Brown Rd. South • P.O. Box 66 Permit Number: ������
Crystal Bay, Minnesota 55323 Date Issued:
t?�./1�/'��
(612) 473-7357
SITE ADDRESS: i'3�� :�H��RE�It�tE D�t
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REMARKS:
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APPLICANT/PERMITEE SIG ATUFiE ISSUED BY:SIGNATUR fICJ
� CITY OF ORONO - BUILDING PERMIT APPLICATION
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� Total Fee: $ - �- ����ti- Date Received: '��' �a-
Date Approved:
Entered By: ��`` L� Z��+
� Permit#: 1
AT•T• I:NFORMATION MUST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL BS STARTED
(See Check-off List Enclosed)
-------------------------------------.-_--�----------------------------- --
THE APPLICANT IS: (circle one) ( OWNER -or CONTRACTOR
JOB SITE ADDRSSS: / �;�=� `%i�z�'f� ?ti� L�C' ' ZIP: -_ - > `l %
���� L.."- ,,�
(work) �1 7� �'`���
�, .-��"G�� . 4 �_ �,
� Cc-F.�'�p �i�t��/� d ��'c���T ��v�'� PHONE: �home) / �� S Z ��
NAME OF OWNER: r z1��� _
MAILING ADDRESS: ��"k � ��.- CITY: C�,'rr�� ,`.'%1�/ ZIP: '��"?.? __
CONTRACTOR: pg���
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINE:ER: PH��=
MAILING ADDRBSS: CITY: ZIP:
p�g: R.EGISTRATION #
�
TYPE OF WORR: New Addition Accessory Structure� Move
Demo Remodel/Alteration Renovate Land teration
-
PRO�OSED W (describe in detail) : ��l'T % i � :-�i`-'�''�%�'r S�����'
4 �
���`=�T7�L ,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: G�1R1fGE STALLS: ATT. DET.
$STIMATED CONSTRDCTION VALII�TION (escluding land) : $
I hereby apply for a building permit and I acknowledge that the information
above i�, 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
undeistand this is not a permit and work is not to start without a permit; and
that �the `work will be in accordance wit the approved plan.
',/ t / / r � �"�
APPI�ICANT'S SIGNATIIRE: <� / ' C�/�� DATE: /� l '��_
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�` �� CITY of O�iONO
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�� 5(M Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
•
s� - � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would 3ike to inform you that your request for a permit or
Zicense 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 wil.l 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 Iicense.
3. The information may be shared with other Iocal , s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Council ac�ior.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
r data on yourself.
6. Your full name is required to process this appl.ication or
pe?-mit.
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C l`\� i__ Q �� � ME2 �'iG S�l t C�i�c, C� (w2GL� A'�Iv'��rN�
.� 1
First Middle Last � � '���t�l-�Gti�
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Address
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Ci_ty tate Zip
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Phone
I understand my rights as stated above.
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BUILDING&ZONING—473-7357 • ADMINISTRATION&FINAVCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSI'VG