HomeMy WebLinkAbout1994-005961 - temp sign PERMIT
_ - �ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number:
Orono, Minnesota 55356-0815 �"��€'�'�
(612) 473-7357 Date Issued: t�i?�:y�,i
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SITE ADDRESS: -
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
. � CSTY OF ORONO - BIIILDING PERMIT APPLICATION
o� � Date Received:
Total Fee: $ �� '
Date Ac�roved: '
� ` /� �
Entered By: Permita: � �
AI�L INFORMATION MUST BS SIIBMITTED IN FiJLI� BEFORE PLAN REVIEW WIIZ BB SZ;�RTED
(See Check-off List Encl.osed)
-----------------------
T� AppLIC�NT IS: (circle one) OL�INER or CONTRACTOR
JOB SITE ADDRBSS:
��U "�'/ s�'t ��Q�i-, ,�� ZIP: S S � � �
(work) y?�- � � ��
NAME OF OWNERs
S�f-c �-c 1^/�i Q,.� �i PHONE: (home) � 7/� 1 7" "
MATI�ING ADDRESS: �C Q � 5�i o��(�`' P �� CITY: ,/�����/� ZIP: SS 3 `� Z
PHONEs
CONTRAC'rOR:
MATZ�ING ADDRESS:
CITY: ZIP:
STATE LICENSE: �
PHONE:
ARCHITECT/ENGINEER:
MAII�ING ADDRESS:
CITY: ZIP:
NAME_ REGISTR�TION a
Additian Accessory Structure Move -
TYPE OF WORR: New Renovate Land Alteration
D�o Remodel/Alteration
. �.� �
PBOPOSED WORR (describe i.n detail) : �' �ta��� � � � � ����
� G dCt-1 � �o S�G�2( r,�e �/� ��
STORIES:___ SQ• FEBT OF EACH FLOOR:
NO. OF BEDROOMS: GAR�GE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacinding landl : $
I hereby apply for a buil.ding permit and I acknawledge that the information
abave is complete and accurate; that the work will. be ia conformance with the
ordinances and codes of the City and with the State Building Co ee�i haand
understand this is not a permit and work is not to start without a p
that the work will be in accordance with the approved plan.
� � � ` � �� s- � �f
DATE:
APPLICANT'S SIGNATQRE:
• �' I� � �S��"� . . . . . .. . . � - - � . .
_ . . . � `.��-.�,,'_ �`t
.
�
CI'�"Y O� O�►'ONO
Post Office Box 6&•Crystal Bay,Mianesota 55323•Municipal Offices
. � .
� _ s � On the North Shore of Lake Minnetonka _
DATA PRSVACY ADPISORY
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 license requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or license.
3. The information may be shared with other local, 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��or.
to approve, some information may become public.
�. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required to proc�ss this application or
permit.
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First Middle Last
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Address
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�ity State Z1p
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Phone
I understand my rights as stated above.
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BUILDING&ZONING-473•7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING