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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: :3:;�?�� '=�H3�REL I�IE DR L`=�U F'. I .hi. i � .7-1 �.�`~:cti�—[�.t�.—t1�.tt�:� DESCRIPTION: �{�"�t�_II_f{=,'T��FI'i-1_i�� E�uil��i���� F'_rr�tit. Ty��� '=,l=—r=jC�L?�'�iE�,►=��=�L.. 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'• �S� _.� . ._.�'. �'� �. � � � ^ � �/W b�/`� ,�(� �vv � 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 � � . � - ' f •`' � � ��'_��.'o� ���I�T� 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 �