HomeMy WebLinkAbout2000-P03405 - temp sign PERMIT
C I � -l� O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P03405
Crystal Bay, Minnesota 55323 Permit Type: sign Pe�it
(612) 249-4600 Date Issued: i2nsi2o
SITE ADDRESS: 3333 Shoreline Dr
WAYZATA,MN 55391
P I D: 20-117-23-11-0024
DESCRIPTION:
Proposed Use:
Permit Class: General
Permit Type: Sign Permit Permit Sub-type(s): Sign-Temporary
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: Va�uation: $ 0.00
TOTAL FEE: $ 35.00
APPLICANT: �CHARD BLOMQUIST OWNER: MGT COMPANY
1430 CTY RD 3333 SHORELINE DR
INDEPENDENCE,MN 55359 WAYZATA MN 55391
THE UNDERSIGNID HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND
STATE OF MINNESOTA BUII,DING CODE REQUIItEMENTS.
1
, � G�.r' /7�J''
LI I E ISS DBYSIGNATURE
Copies: City,Applicant,Assessor,Finance Page 1
� �'ota.�Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWN ' R CONTRACTOR
JOB SITE ADDRESS: �J �3 O�V e //�'I (d �Y ZIP: S�J � Z-
NAME OF OWNER: 1'9� �2Y� ^ 70� NE: (home) � �/- Z Z�-6
o/' (work)
MAII.ING ADDRESS:I��� �-�"J �� . CITY: � ZIP: '^� ��
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAIVIE; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain�/�"►7 �7`�' ����.� /�� ,
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIATED CONSTRUCTION VALUATION(exclud.ing land): $
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be ui conformance with the ordinances and codes of the City and with
the State Building Code; that I understa this is not a pe ' d work is not to start without a
permit; and that the work will be in c ce with the p oved plan.
APPLICANT'S SIGNATURE � DATE: 9p�'"�� DL/
NOTE! Parade Qf Homes e ents require separate perm' approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
.. , -
Sea13.04 RIGHTS OF S[JB.TECTS OF DATA
Subd. 1. Type oE'data. The righ[s of individual on whom the data is stored or to be stored shall be as set for[h in this section.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)che purpose and intended use of the requesred dara within the collecang 3tate agency,polirical subdivision,or statewide system;
(b)whether he may refuse o'r is legally required to supp(y the requesud dara;(c)any laiown consequence arising from his suppiying or refusing to supply
priva[e or confidendal dara;and(d)the idenary of ocher persons or enrides auchorized by stace or federal law to receive the data. This requirement s6aii
not apply when an individual is asked to supply invesrigarive dara,punuanc to secdon 13.82, subdivision 5, to a law enforcemenc o�cer.
The commissioner of re�enue mav place the norice rewired under this subdivision in the individual income tax or propertv taz refund
instcuctions ins[ead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whether ic is classified as pubiic,private or confidendal. Upon lus further requesc,an individual who is the subject
of stored private or pubiic dara on individuals shall be shown rhe dan wichout any charge to him and,'if he desires,shall be informed of the content
and meaning of chat data. After an individual has been shown the private data and informed of its meaning,the dara need not be disclosed to him for
six mon�s thereafter unless a dispute or acaon pursuant to this secdon is pending or addidonal data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the dan. The responsible authority
may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shalt comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shatl so inform the individual,and may have an additional five days within which to compiy with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in wridng the rosponsible authoriry describing�tte nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incompiete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by che individual;or(b)nodfy the individual thac he believes rhe data to be correcc. Dara
in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data.
The decerminadon of the responsible authority may be appealed pursuant to the provisions of the administrarive procedure act relating to
contested cases.
DATA PRIVACY 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 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 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 shazed with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6, Your full name is required to process this application or permit.
First Middle Last
Address
Ciry Stace Zip Phone
I understand my rights as stated above.
Signa[ure