HomeMy WebLinkAbout1992-004849 - temp sign P�IZMIT
CITY OF ORONO PERMIT TYPE: �=;t�;;�
1335 Brown Rd. South • P.O. Box 66 Permit Number: �������=�-'�
Crystal Bay, Minnesota 55323 Date Issued: i i f i r:=:;!°a�:�
(612) 473-7357
SITE ADDRESS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: �' ��'F`� ��'�'—'�. �'
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APPLICANTIPERMITEE SIGNATU ISSUED BY:SIGNATURE ,�,a�/
CITY OF ORONO�- BL�ILDZNG PER�i1T APPI�ICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: u, (��c f�
Permit,r.
ALL INFORMATION MIIST BS SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL B8 STARTED
(See Check-off List Enclosed)
--------------------------------------------------------
THE APPLICANT I5: ( circle one) O��INER or CONTRACTOR
JOB SITE ADDRBSS: -� 7-7-5 `-:� �1,`'p,C � 1✓1 `E' 1� � ZIP: � � � � � t/ li
�j1�-L�/�-ic K �- ��..� . (work)"7 / �"�7 /�
f ' � _����'(` �l i �, " � l PHONE: (home) 7��'C��=�,7
NAME OF OWNER: � ��� ►41 �' C� �=' � � �
� . �,��� 3 ��'Z
� �� �� / � ? =r� � �� �- CITY: ���1�'� m� 1 E ZIP:
MATLING ADDRESS: ���-�=--> �-�� � 1 � �'� -
CONTRACTOR: PH��'
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PH��'
MAII,ING ADDRESS: CITY: ZIP:
NAMF: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure rlove
Demo Remvdel/Alteration Renovate Land Alteration
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"n detail) : !71 //l�G�'� _�-� � /;��/,�i� //;l ) ��'3/��
r�oros� woxx (aescr�Le �
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl : $
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 pe�►it as�d work is not to start without a permit; and
that the work will be in a�ce�orda�i.�e with�he approved 1an. �
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-�'"��"`.� ��//�� ,G ;% DATE:�� � //
APPLICANT'S SIGNA - - ��
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^�� _ . f��_ Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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`���� ��' On the North Shore of Lake Minnetonka
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DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of
data", we would Iike 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 Iicense 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 local , s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or bec me e ub q�ires Councii actior.
to approve, some information may P
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to process this application or
permit.
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gnature
BUILDING&ZONING-473-7357
• ADMINISTRATION&FINANCE-�73-7358 • PUELIC WORKS -473-7359
ASSESSING