HomeMy WebLinkAbout1991-003692 - temp sign permits - 1'ERMIT
��4Y•OF ORONO PERMIT TYPE: _����_
1335 Brown Rd. South • P.O. Box 66 �!'};�;�_,_-��=
Permit Number: E_�r���.��f
Crys#al Bay, Minnesota 55323 Date Issued:
(612) 473-7357
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APPLICANT/PERMITEE SIGNATURE UED BY:SIGNATURE
� - " CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
ALL INFORMATION 1KDST B}3 SLTBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
----------------------------------- ------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: ��`� =����/�Z�/ll� OCir/ri ZIP: lj S � /�
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(work) �i''7l - ���
NAME OF OWNER: PHONE: (home)
1riAILING ADDRESS:.3(�9.�����t�''�pG�iv�,�iL� CZTY:;�/?�2tL� ZIP: 5 5 �`�;�
CONTRACTOR: PHONE:
MAILING ADDRESS: CITY: ZIP:
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) :
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BBDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATSD CONSTRUCTION VAI�DATION (excluding land) : $
I hereby apply for a building permit and I acknowledge that the information
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 the approved plan.
APPI�ICANT'S SIGNATQRE: � DATE: �
(Please fill out the reverse side of this form)
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n-t�ts�at r� �C�a CITY of ORONO �
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' � '�� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
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� � On the North Shore of Lake Minnetonka
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DATA_ PRIVACY AD_VISORY �
In accordance with M.S. 15.165, "Rights of subjects of data", we
would like 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 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 , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some inf ormation may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself .
6. Your full name► and date of birth are required to process
this application or permit.
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First Middle Last
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Ad ress
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City State Zlp
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Phone
I understand my rights as stated above.
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Signature
BUILDdNG&ZONING—473•7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING