HomeMy WebLinkAbout1993-005513 - tearoff/reroof � PEI�MIT �,:.
CITY OF ORONO PERMIT TYPE:
�275U"Kelley Parkway • P.O. Box 815 Permit Number: E�E J I LC�I f�i��
Orono, Minnesota 55356-0815 Date Issued: =}t'�`'��=
(612) 473-7357 ;�'�/��;�=:=:
SITE ADDRESS:
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- P I NT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ��GL� .
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t � CITY OF ORONO - BIIILDING PERMIT APPLICATION
.
Total Fee: $ ��7"• i J _ Date Received:
Date Approved:
Entered By:� -
Permit#: '�J`�� 3
ALL INFORMATION MIIST BS SIIBMITTED IN FDI�L BEFORE PLAN REVIEW WILL BS STARTED
(See Check-off List Enclosed) �
-----------------------
THE APPLICANT IS: (circle one) O�+7NER or _ NTRACTOR
JOB SITE ADDR$SS: �_i'/�� �hOr��/�� 4/�� ZIP: �����
(work) % �� l/�
NAI�: OF OWNER: � � PHONE: (home) ��4 ���� -
MAII,ING ADDR.ESS: ��D, �ff/f 2�/,f��-F{/�p �CITY: ��i�� Z IP:-s����a I
�3�—�4�a�
CONTR�CTOR: �- l�/ •v— r PHONE: ����.�-S�b
MATI�ING ADDRSSS. /DD/ ������� cIT�: � � zzp: ...�.�-��93
STATE LICENSE: # ����
ARCHITECT/ENGINEER: P$��'
MAII�ING ADDRESS: ZIP:
N��: REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move �
D�o Remodel/Alteration Reno�e Land Alteration
�'�
PROPOSED WORR (describe in detail) : � �
STORIES: SQ. FEET OF EACH F'LOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
2 r
ESTIMATED CONSTRIICTION VALIIATION (egcluding Iand) : $ v�O� �
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the w rk will be in conformance with the
ordinances and codes of the City and the State Building Code; that I
understand this is not a permit d w s not to start without a permit; and
that the work will be in acc the approved plan. �
APPLICANT'S SIGNATOIZE: DATE: /
,
s. , . 1
.
� Olf oRONO
CITY
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� � � � On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of sub er�t or
data", we would like to inform you that your request for a P require
license from the City of Orono or any of its departments may
you to furnish certain private or confidential information.
� You are notified that:
- 1. The inf or fo lthey�ermit or licensebrequested, determine your
qualification P
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 ot rocesscthe pe�it �r
federal agencies to the extent necessary to p
Iicense.
4. If your requested permit or Iicense 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 process this appl.ication or
permit.
� ��
��G� / O�
First
Middle Last
5���� C��,� �
Address �� a��
�� J
`�%?�j�tiG r�s�' i���
City State Zip
�.�' y� 08 ��
Phone
I u ers rights__as stated above.
gna re '
BUILDING&ZONING—47 -7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING