HomeMy WebLinkAbout1994-006030 - outdoor sign , P�RMIT
` ' CITY OF ORONO PERMIT TYPE: _
2750 Kelley Parkway • P.O. Box 815 Permit Number: '�`'��
Orono, Minnesota 55356-0815 '''���''`}'''`j
(612) 473-7357 Date Issued: :�.•-� ���
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CONTRACTOR: OWNER: — _�::_:;;,. ; �._t,�t. —
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AP LI NT/PERMITEE SIGNATU � ISSUED BY:SIGNATURE �-�
y CITY OF ORONO - BIIILDZNG PERMIT APPLIC�TION
n �
Date Received: " J � � � �
'^otal. Fee: $ �``-���
Date A��roved: �
Entered Bv: ��� Fer*nit�:��C�� _
p,LI, IN�gORMATION MIIST BS SUBMITZTED IN FULZ� BEFORE PL.AN REVIEW WII�L BE Sg�RTED
{See Check-off List Enclosed)
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,.� �PLI�rJT Ig: (circle one) �r CONT_RACTOR
� /�f J� L /�ti�� L J/( f �- � ZIP:����� l �
JOB SI�E ADDR:SSS��-� C/ /� ` ' —
/��JJ��� , � c� � (work) ���'� ��
-�J /� � PHONE: (home) L��/ / �o�a�J�
NAME OF OWNER s � ��/�✓ �`�� ���,
MATzzxc AnDxEss-l�/�3 G �' `TC/ �� �,� _ ci��,,��'%��� zzP: ,����I
CONTRAC'rOR=
� G�� ) �� �� � PHONE: '7 �v`Z- � U l, �
� CSTY: ZIP:
MATI,ING ADDRESS:� � � i � ' � —
STATE LICENSE: �
PHONE-
r�RCHITECT/ENGINEER:
2dAII,ING ADDRESS:
CITY: ZIP-
REGISTR�TION z
N�:
Additian Accessory Structure Move
Z•ypE pg j•7pRK: New Renovate Land Alteration
D�o Re.*nodel/Alteration
PROPOSED WORR (describe i.n detail) : � `/ X� � U �'��"�/` `� ` ��
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STORIES:
SQ. FEET OF EACH FLOORs t
Np. pg BEDROOMS: GP.RAGS ST�LS: ATT. DET.
ESTSMA�ED CDNSTRIICTION VALIIATSON (eacludinq
lana) : $ /o"?� ��
I hereby app I-y
for a building permit and I acknowledge that the iriformation
above is complete and accurate; that the work wi11 be in conform c ae Withat I
ordinances and codes of the City and with the State Building e�it; and
understand this is not a permit and work is not to start without a p
that the work will be in accordance with the approved p lan•
DATE s "�� �
APPLICANT'S SSGNATORE:
1
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� � (��[�"�' o� ��►(�N�
Post Office Box 66•Crystal Bay,Minnesota 55323•Muaicipal Offices
!
� _ � � On the North Shore of Lake Minnetorcka _
DATA PRSVACY ADVISORY
In accordance with M.S. 13•ou'that your request for a perm t or
data", we would like to inform y re uire
license from the City of Orono or any of its departments may Q
you to furnish certain private or confidential information.
You are notified that:
1. The informati�hey ermitnor li ensebrequested. determine your
qualification for P
2. You may refuse to supply data, but refusal may require that
the City deny the permit or license.
3. The inforraat�o the extenthnecessaryhto processcthe perntit or
federal agencies
license.
4. If your requested permitmar become p b�� res Councii ac��or.
to aporov e, s o m e i n f o r m a t i o n y
5. You have certain rights under M.S. 13.Oa to review private
data on yourself.
6. Your full. name is required to procsss this application or
pe�-mit.
1� - �S
�l� Middle Last
First
1 �-i �c� C � 2-� � �
Address
�� ��--,.��I� � �
City
State Zip
�-�� � - o���
Phone
I understand my rights as stated above.
\ .
Signature ' � �
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING
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