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. . �� PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 � ��
Crystal Bay, Minnesota 55323 Permit Number: v _�':t�:�_. _
Date Issued: � �'"V" `��
(612) 473-7357 r.:.':'�.:_::'.`_��-
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO - BIIII�DING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: permit�:
ALL INFORMATION MIIST B$ SIIBMITTED Ir7 FIILZtBEF�RESe�AN �I� �� B$ STARTED
(See Ch ---- ----------------------------
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TgE APPI,ICANT ISs (circle one) OS�1NE or CONTRACTOR
JOB SITE ADDRSSS: � � S�V``�UD ZIP: S� �"� �
���5 � ��1►�/� � ' (work) `� � "� �o c`�
NAI�: OF OWNER: S 1�t11'�- (n,��="-�—� PHONE: (home) �2--_�� 1 O
MAILING ADDRESS: 5�w--�' '�
R'IY�o t/��--_ CITY: I�l/1��„2--r�1 Y S' Z IP: J���l �
PHONE:
CONTR�CTOR:
MAILING ADDRESS: CITY: ZIP: �
STATE LICENSE: #
ARCHITECT/ENGINEER: PH���
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTR.ATION tt
TYPE OF WORR: New Addition Accessory Structure
Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : ��/�� S l�i� �^ �� r�'�'�
�, �'-'�
STORIES: SQ. FEET OF EACH FLOOR%
pQ. �g g�gpp�: G�GE STALLS: ATT. D ET.
ESTIMATED CONSTRIICTION VALIIATION (e.scluding land) : $�
I hereby apply for a bui ing permit a I acknowledge that the information
above is complete and ac rate; that t ork will be in conformance wi�h �hI
ordinances and codes o he City and with the State Building Co ermit; and
understand this is not ai ermit and w k is not to start without a p
that the work will be in� ccordance w' h t pproved plan. �
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APPLICAPIT'S SIGNATURE:
� DATE: 1 � �
�.. . 1
` ITY of 4RON0
C
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� _ � � On the North Shore of Lake Minnetonka
DATA PRNACX 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 f rom the City of O at�o=r �onf dent al e nf rmationmay require
y o u t o f u r n i s h c e r t a i n p r
You are notified that:
1. The inf orma��i�heY°ermit or Iicensebrequested, determine your
qualification f P
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 Iocal, s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Councii ac�iar_
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 prvc�ss this application or
permit.
S l �1 . ��
First
Middl.e Last
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Address �
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Ca�� ,�,��� .
City State Zip
�4'1 --� �_
Phone
I und stand my rights as tat ab ve.
Signa . �
BUILD[NG&ZONING—473-7357
• ADMIIVISTRATION&FINANCE—373-7358 • PUBLIC WORKS—473-7359
ASSESS[NG