HomeMy WebLinkAbout1992-004672 - re-roof/tear-off PERIiiIIT
CITY �F ORONO r � PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 E���I LC�I t��"�
Permit Number: ��t:j4F,7�z
Crystal Bay, Minnesota 55323 Date Issued: 1�-���}f!'��'
(612) 473-7357
SITE ADDRESS:
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L`=�U
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REMARKS:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE C��r
+ CI'rY OF CRC:IO - BJILDI27G FErrt.'�-I'i APPLICATION
�� . , .
Total Fee: $ ;,Z��1` �� Date Received:
Date A�proved :
=ntered B� � _ 1. ,-/ �; ' ."
Pe�it - -
AT.T. INFOR.'�iATION MIIST BE SUBMITTLD IN FULL BEFORE PLAN REVIEW WI� BS STARTED
(See Check-aff List Enclosed) �
--------------------- -. m _
�E APPLICANT IS: (circle one ) O�v�1ER or CONTRAC_OR �
r, '4 �'
70B SITE ADDRBSS: J� �S L� � � ` 1 ZIP: �5 ! I
(wark)
:7� OF OWNER: � �-+-� y� �-- L\�^ r► �-'"�-- PHONE: (home)
�AII�ING ADDRESS: CITY: ZIP:
\ �
CONTRACTCR: c.�'/�` l-- �-�`� "__��"`U i:.�/ c:� .ti� `�� c_ PHONE: %2-�j� C�' �/2�
,a �u-rti-, r��..� ���_. cI TY: d. l,c�,�s `r�.� Cc_ z IP: S5��.�
._ASZ,ING ADDRESS: �� l��� � , FJ �X
STATE LIC�:`7SE: T
�nCHITECT/ENGINEER: PH���
.AIZING ADDRESS: CITY: ZIP:
�AMF: R.EGISTRATION T
��� Accessorv Structure riove
=r*vpE pg y�;p�ZK: �7ew �f Addition _
Demo R�*nodel/Alteration Renovate Land Alteration
� I/ f, ' ��
�ROPOSED WORR (describe in detail) - 1 � �`�x � •
�� '� (�d
�, �
��J 'Z .rX�e-„ -t�G� � � �.-
�TORIES:__�_____ S4• F�T OF EACH FZ,OOR= `7'�7 `�
:�70_ OF BEDROOMS: G�,RAGE STAI�I.S: ATT. DET.
?STIMATED CONSTRIICTION VALUATION (ezcluding Iand) : 5 13 �>C�==
: hereby apply for a building per-iit and I ac?c.^.cwiedge that the infor:nation
.bove is complete and accurate; that the work wi� 1 be in conformance with the
�rdinances and codes of the City and with the State Building Code; that I
:dnderstand this is n a permit nd work is not t� start without a permit; and
�hat the work wil.l be i�t� acco a e with the approved plan. �
C�n.�n. ^
DATE: � % �"'
c'�PPI.ICANT'S SIGNA �
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Post Office Box 66•Crystal Bay,Minnesota 5a323•Municipal pffices
0
s - s 4 . On the North Shore of Lake lifinrcetonka
DATA PRSP�CY 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 �
Iicense 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 Iicense r=�uested.
2. You acay refuse to sunply data, but re=usaZ may require that
the City deny the permit or license.
3. The inf ormation may be snared with vtzer Iocal. , s�a�e or
federal agencies to the extent necessary to process the permit or
license.
a. If your requested perinit or Iicense =BCL71Z"eS Councii ac��o%
to approve, some information may become public.
5. You have certain rights under M.S. 13.C� to rev�ew grivate
data on yourself.
6. Your full name is required to process this application or
pe=-mit.
S�r�v �l � S�-�-�� I
First Middle Las�
O�s � � J � S I � �-
Address
���,�3 c� 1�/1 v�j ��`�3 � �-
City State Zip
`�7�� 2 J y .�-�
Ph ne
I u erstand my 'ghts as stated above.
S ' gnature . '
BUILDING& ZONI�G -473•7357 • AD�tINiSTRATIO�I&FINAVCE-473-73:3 • PUBLIC WORKS -473-7359
ASSESS[NG �