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' PERMIT
CITY OF ORONO PERMIT TYPE: ,_;��_��
1335 Brown Rd. South • P.O. Box 66 Permit Number: {z{;��.;�-;+_,
Crystal Bay, Minnesota 55323 Date Issued: i f_:i�_�i��:=�
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: 10 days max, must be out of right-of-way, ;�:�r,�T,} ;•��,� r�r,4 lThafia
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FEE SUMMARY:
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CONTRACTOR: � ,��Tr=� �=��-(i:���'�i�������`'�1
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATU �`Z .
�
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ 7J�°d`� Date Received:
Date Approved:
� Entered By: C�J Permit tt: (J��S
�l
AT•T. INFORMATION MUST BS SDBMITTED IN FIII,L BEFORE PLAN REVIEW WILI. B$ STARTED
(See Check-off List Enclosed) �
-----------------------------
THE APPLICANT IS: (circle one) O��7NER or CONTR.ACTOR
JOB SITE ADDR$SS: �C,o b� � ��l M-'� ��� ZIP: �^3� Z
(work) � � � ""1�a�
NAME OF OWNER: S1�'.��� l/�V` �� PHONE: (home) �(�2-731�o
iKATLING ADDRESS: �� ��+�-�-a�'� �'\• CITY: C7(�NZ� ZIP: ��^��I�
��yy �
CONTR�CTOR: '�- P$��
MAII.ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: `"` PHONE:
MAILING ADDRSSS: CITY: ZIP:
N��: REGSSTRATION A
TYPE OF WORR: New Addition Accessory Structure Move �
Demo Remodel/Alteration Renovate Land Alteration
� St � �,
PROPOSED WORK (describe i.n detail) : 3 k� � � ���
r�t-�.�P v�►�v��� � ���,i� -- �-c� ��th� c
STORIES: SQ. FELiT OF EACH FLOOR:
NO. OF BBDROOMS: GARAGE STALLS: ATT. DET.
ESTIIKATTED CONSTRIICTION VALIIATION (eacluding I.and? : S
I hereby apply for a buil g permit and I acknowledge that the in�a�atior
above is complete and acc�} e; that the work will be in conformance with thE
ordinances and codes of �th City and wi t e State Building Code; that -
understand this is not a �e mit and work s no to start without a permit; anc
that the work will be in 1a ordance with he proved plan.
, .
APPLICANT'S SIGNATIIRE: A�: ������
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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 Iike 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 confidential 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 Iicense.
� 3. The information may be shared with other local, s�ate or
. federal agencies to the extent necessary to process the permit or
license.
' 4. If your requested permit or Iicense requires Councii ac��or.
- to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Yaur full name is required to process this application or
� permit.
�
-�,,,, ,� -�1v�P(l� �-�t,n/�- �,.� . �-t i1-�-�►�
First Middle Last
' �_��� ���i�.�'l.� �---t /�/(�- i�`�l �
Address
o,�� �/1� �3�2.� _
City State Z1p
�� 1 � �'i7 �o
Phone
I u er tand my righ a stated above.
Signa re .
BU2LDING&ZONtNG—473-7357 � ADMINISTRATION&FtNANCE—473-7358 • PUBLIC wORKS—473-7359
ASSESSING
-�
�
C�C� OFF LIST FOR ISSIIANCE OF PEF2MITS
FaR OFFIC: USE ONLY
ADDRESS OR I�'''G�L: 3�0(�� SHO�Cr1/�C� D� PID:
DESCRIPTI ON OF WORR- 'T Nn P S ((�N
----------------------------------------------------------
ZONING R.EVIEW BY: � nn,�,� DATE APPROVED:
BIIILDING REVIEfnI BY: /V I lR DATE APPROVED: 3 `1(�'S3
-----------------------------------------------
FEES TO BE CSARGED• Misc. rees Calculated Bv:
TL�N'�/� SIbN FE�
PERMIT Yes ��No-
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes�? No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of S�C Units OTHER (saecifv)
------------------------------------------------ -
ZONING CHECX LIST Zoning District:
Fire Depar�;nent:
Post Office: School Dist=ict:
Lot Area: W� dth: De th:
;
Survey Submitted: Yes N Date of urvev: - �
Pronosed Setbacks : �
� Front (Lakei : Right ide :
P.ear ( Street ) : Leit ;�Side:
Adjacent Struct res : W ��an
.__.__.—.—
Building fieight: D �. Hgt. � Pea Hgt.
Avg. Setback: � Lot Cove age:
Existing j P opos d
r
Hardcover: G-75 '
i
75-250 '
25a-500 '
500-I000 `
Hardcover Vari nce Require : Yes No Date of Council Approval:
Grading- Staf Approval Da B : Council Approval Date:
Septic: Staf Approval Dat :
Zoning File-� R solutio �- Resolution Date: �
'�,-,,.,___ �
��tAR7CS (in house) : �
�
,
. _ _ .___ _ _ .__,_ _ -� -, ..
3III?�DI:7G REVIEW C3�G� ZIST
�gC: - CONS2'QIICTION TYPE: --
SQ Footage S Per Sq Ftg
��5��':er+ X =
lst Floor X
2nd Floor X
Garage X =
x
TOTAL
Estimated Constrnction Value: $ ----
Iaspections Required: Wor3c Reqniring Separate Pesmi.ts:
Site Plumbin Grading/Filling
g
Mechanical. Fire
Footing Water Connection
rraming Septic
Insulaticn r^�replace Sewer Connection
Wal? Board (Mascnry} Otner y
(Mfg. ) Well S�ate Permit
Final Electrical (State Permit)
---Otne------------------------------------------------------------------------
REMARRS (IN HOUSE) :
---------------------------------------
?2E,'VIEW BY OTHERS: DATE:
Access : Exis`inQ New
Access Approval. Date �y ____________ _________-
RRMARK$ (TO B$ NOTSD ON PF.RMIT)---i 0 - U��,S -�-'4 -- ►'�'w5 r C3E O�'- � � 2"t�'�`'�"
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