HomeMy WebLinkAbout1992-004730 - reside area only PERMIT
� �TY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 �������}����
Permit Number: e'_ii��.�:;t�
Crystal Bay, Minnesota 55323 Date Issued: 1 C�/�'f�'�:�
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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APPLICANT'PE ITEE SIGNATURE ISSUED BY:SIGNATURE
� � CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
� Date Approved:
�
Entered By: Permit#: `���U
ALI, INFORMATION MDST B$ SIIBMITTED IN FIILZ BEFORE PLAN REVIEW WI?�L BE STARTED
(See Check-off List Enclosed) �
------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: � ��� � � ZIP: S�39�
�i�-o�Q �; .L,� �r- (work) 4�o •-O 66 3
NAME OF OWNER: Qa�'` �",�i�w5 on� PHONE: (h ome) �l?�-�'S'o'�
MAILING ADDRESS: 3� VJa-�r 5�'�-� CITY: ���lSior ZIP: S-S33/
CONTRACTOR: �-e �� pH��'
I�lAILING ADDRESS: � CITY: -' ZIP: ^
STATE LICENSE: # ^
ARCHITECT/ENGINEER: ��- ` � PHONE: —
MAILING ADDRESS: CITY: � ZIP: ^
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p��: �' REGISTRATION #
TYPE OF WORR: Ne Addition Accessory Structure Move
Demo emode Alteration�_ Renovate Land Alteration
. 5 � �-'�5;���^y
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PROPOSED WORR (describe in detail) : � ������ S'���15 � � bia'�'Q'�
C�m crc.t b�o u U w o o S���� ct,�� a.�- ��e
p a��. �o o� ��. �r�s�� . 30'x ►a' S,� o-� s� {��,�:
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STORIES: � SQ. FEET OF EACH FLOOR: �,70 0 p v r S,�a C e
NO. OF BBDROOMS: O G�,RAGE STALI�S: ATT. O DET. O
ESTIMATED CONSTRIICTION VALIIATION (eacluding land) : $ 30p�d0
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 accordance with the approved plan. �
' APPI�ICANT'S SIGNA DATE: �� -19'�d
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� � � � 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 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 confidentia3. information.
You are notified that:
1. The information you furnish wil.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 I.icense requires Councii action
to approve, some info�mation 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 proc�ss this application or
permit.
IJCt,n��e- � Sd�r� /' 'a-�h u.5 tl n�
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��00 v�-e-s t f1-r►�. � � 30/ -
Address
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City State Zip
It �f �l - gsoN w .. �(7o-oc�� 3
Phone
I understand my rights as stated above.
F.�+�t
Signature • �
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 ,
ASSESSING