HomeMy WebLinkAbout1992-004224 - sign t emp PERMIT
CITY OF ORONO PERMIT TYPE: :_,;�;�,�
1335 Brown Rd. South • P.O. Box 66 PermitNumber: ���t%��'��.
Crystal Bay, Minnesota 55323 Date Issued: i�:��i':�:�;,`'=t�
(612) 473-7357
SITE ADDRESS:
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PLICANT/PERMITEE G ATURE ISSUEDBY:SIGNATURE ��..�
CITY OF ORONO � BL;�LDING PERMIT APPLICATION
Total Fee: S ��' � Date Received: � '�3 - I�Z
.�+�' Date Approved:
Entered By:
Permit#: `7� ���
AT•T• INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OPiNER or C�NTRACT�
�.� ' �
JOE SITE ADDItBSS: ��1 � _������� ! ti�'� �� ���Ir: S � S t �
(work) �7�-�7L�.1
f 1 � 7
NAME OF OWNER: ��I� v r_ v'v i"j ���u "✓y�L PHONE: (home) ri 2 �7 3 I V
MAILING ADDRESS: I�i��C � � l� CZTY: L�J-A-�,��+�'� ZIP:���Z
CONTRACTOR: Pg��=
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: P$��=
MAII,ING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
� �� /
PROPOSED WORR (describe in detail) : ���ti ^� �t i� ` �� T� �
'J (�-r�� � � � �-v
STORIES: SQ. FEBT OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALI.S: ATT. DET.
�� .:_
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ '� �
I hereby apply for a building permit and I acknowledge that the informati�n
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 will be in accordance with t}� approved plan. •
I
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APPLICANT'S SIGNATQRE: \ ti �� -- DATE: � "-Z � �- � �-
-- 3
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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 confidential information.
You are notified that:
1. The information you furnish will 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, state or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or license requires Council. action
to approve, some information 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 process this application or
permit.
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First Middle Las
3 ���1 S� �� � , ,�� � �
Address
!v��-(� 2 v�l,�i �5��z
City State Zip
�{ � � _ �7 � �
Phone
I understand my rights as stated above.
,
Signature .
BUILDING&ZONING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING