HomeMy WebLinkAbout1992-004496 - temp sign 4 PERMIT
��TY OF ORONO PERMIT TYPE: �=IGN_
13,35 Brown Rd. South • P.O. Box 66 PermitNumber: t}{}�'�'��'
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Crystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357
SITE ADDRESS: i�S� :�:Hi+RELINE Df,
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DESCRIPTION:
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CONTRACTOR: I �.�.���fER - . ��Ht��k! . - —_.___
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WAY�ATA h1N ��:3°�1
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
� `� CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit�:
ALL INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDR$SS:
I���`��_�����=��1 �� Z I P: :.1'`� I
���.��1r L���j G���f��� ���-�l� � (work�7J ��' �
N� OF OWNER: �b-3 �- � PHONE: (home)
MAILING ADDRESS: c� JV�-'�\ l CITY: ZIP:
_=��� � � �, S� / � `%�--
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CONTRI�CTOR: PH��' •
MAII�ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PH��=
MAIZING ADDR$SS: CITY: ZIF:
p�g_ REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
�_�� °'72�'/1 �..��o�'
PROPO WORR describe in deta' '
1�-- I l��L�_ • � ' i . ��� , -��j� � —
_.T L -,� �-��� �'�- � �
STORIES: SQ. FEBT OF EACH FI�OOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (egcluding 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 with the
ordinances and codes of the City and with the State Building Code; that I
understand this is not a permit and work is not to start without a permit; and
that the work wil 1 be in acco dance wit the approved plan. �
APPLICANT'S SIGNATURE: ��'`� DATE: � I �L✓
�� �
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� � � � 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 ].ike 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 wiI.l be used to determine your
qualification for the permit or Iicense 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 Iocal, s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council action
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 process this application or
permit.
First Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature .
BUILDING&ZONING—473-7357 � ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING