HomeMy WebLinkAbout1992-004611 - parking/grading � .� I'ERMIT
�
� �IT'� �� t7RON0 PERMIT TYPE: ��,_; , �����E�
1335 Brown Rd. South • P.O. Box 66 PermitNumber: t?(�,�j���j
Crystal Bay, Minnesota 55323 Date Issued: i r��Ii��.1_=�i
(612) 473-7357
SITE ADDRESS:
i�7t r �TH AVE N
L'=:U
F'. I . N. � '�t�.—i 1��—;�::,—:zL—�:}�:�c��:=:
DESCRIPTION:
F'�S�F�::I h�l��!G�F�Cj I hlt�
l�ser P���tr,i t� TY���- Lt�rt�C! �rLTE��tT i�+N
, � ���� �� � •�� � .
�, � ��, � �� .�.� ����� ��rr oF �.�tr�ro
� ,
� � � �x
� �4 = ���'c 5� �z A � 1�� ����� f���v�Nt�� C�FFI�F
,� �� ��` :� ��'� �� # "� `� �'� �:�1,s;s;��3c� #
��� � �} ���' � � � �� � �J.f GF� St�.44
� ��� �.��� ��,����� �"` � �;fff'�ft' T� 54,t�'
�t ��_ 4 � �� >,,��
�� r �����: ���� �� M�� ,�tti��;�r-r��� �c�u
� �
� -� �� � � ,t �;, ���I3�v L;;L'.# Mt�� T�'�=3�
� ; , � �:_ ��,� � ��, � z .
�� � � � �, L'#:'J�:�t
� � \.� � .�' �
} ,
; �� � � , �
w}y ��� � a4 �,
` �� � � �� ���
'," :� _,� sr,.r �
REMARKS:
i�AX T Ml1Nf� 1 i�t i �:t!�:I�: YARD:_;
FEE SUMMARY:
E�as� FCC ^_—_—_—^�.��—,�?ycyir
Tt��#�al Fee ���_�.i��i
CONTRACTOR: OWNER: — A��F�1 i c ant. —
�1H I T�IAN .Ji=iHN
f�7�} F�TH AUE M
1 I�I_!�1 i �� �Ci:3SF
f t=.�.;�1,Q.7�"i—:]1{���
___ ___ _ _----_,______ __. _..__ _ _. ___ _---__ --__----__�___
_ ____.-- _. __-- ---- __.._ _ --
T�-!� t ti�1DER:=�I Gi�lED ;�i���E�Y ��;i�fi��=;T'=: h'�r't1 i°���_;i r i{y T�� i'tf�'r�::E THE �:E�L I t i�='�iiiil�:tl�t�l�i���
'=�F'E�:I F I E�Cr �h�C; ��a!;�E'�� Tt�� �;��i !�:?�._ �':��F:k:: I hi �=;Tf;I C:i �:���t�F'L 1 Ht�C:� �l I#;-( �t�€ t:I►'Y i�►F
�
s���i i�.��R �i�'D I Ni�hI�:E�'; r�l��J '=i7€,TE +�ji� i�1 I�i���'=,s i�i� E!?I L�i I tdj,� �=i�UF �i�s:�i.s'���i•��f•�i'_� .
APPLICANT/PERMITEE SIGNATURE SUED BY:SIGNATURE C�
� � CZTY OF CRC'•IO - BUII�DI�IG FER:�-IT APPLICATION
Total Fe�: $ Bate Received: / / Q 7 CZ----
Date A��roved:
,n
�
=�tered By: � �' Permit r: ��� l �
AT•T, INFOXPi�TION MIIST BE SIIBMITTED IN FIILL BEFORE PI�AN REVIEW WILL BE STARTED
(See Check-aif List Encl.osed}
---------------------
-------------------------------------
�E APPLICANT IS: (circle one ) Ojv� or CONTttACTOR
JOB SITE A.DDRBSS- �-��U �;, l�-- �`� � ZIP: ���3=�c�
(wark) ri
`��/ / � ����n PHONE: (home) � 7� � 7�b7
�I�.ML OF OWNER: � / O/',/'J
�.x�zzxc a.�Dx�ss: /�"��� (., f:�, � �t,� cz�r: � o��c. �r.��— zzP: �s����
PHONE:
:.ONTRAC�'OR:
u.AII,ING ADDR.ESS: CITY: ZIP:
STATE LICE:`7SE: _
r�.c2CHITECT/ENGSNEER: PH���
�iAIZING ADDRESS: CITY: ZIP:
,���_ REGISTRATION -
TYPE OF WORR: �7ew Additian Accessory Struc�ure riove
Demo Re.*nodel/Alteration Renovate Land Alte�'atioII�
P�OPOSED WORK (describe in detail) :��/����-� �'�� ✓� -�-°-� ���G —
2 � ' � ^ — .
� ,/,� ` '
STORIES: SQ. FEET OF EACH FI�OaR:
NO_ OF BEDROOMS: G�,FtAGE STALI,S: ATT. DET.
ESTIMATED CONSTRIICTION VALUATZON (egcluding land) : $
I hereby apol.y for a buil.ding permit and I ackncwledge that the infor:nat'on
anove is compl.ete and accurate; that the work wil � be in conformance with the
�rdinances and codes of the City and with the S�ate Building Cede; that I
::nderstand tinis is not a permit and work is nct tc start without a permit; and
�hat the work will be in accordance with the aporoved plan. �
�:,�_.
�' �� � � �'z..-
APPLICANT'S SIG�7ATQRE: - "- - ' � DATE:_�
,t ��o
n a � , 1�� G�� . .
b �C ��� �t � 1� a�c� . -
� �
,�:- -
'-�= �. � -
�-`� ��'��.'o� ����T�
�� Post Office Box 66•Crystai Bay,Minnesota 5a323•Municipal Qffices
0
: � - � g i On the North Shore of Lake ll�finnetonka
DATA PRIV�CY ADVISORY
In accordance with M.S. I.3.04, Subd. 2, "Rights of subjects of
data", we would Iike 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:
l. The information you furnish wi�I be used to determine your
quaiiiication for the pe�-.nit or Iicense re�uested.
2. You nay refuse to supp?y data, but refusal may require t'�at
the City deny the permit or license.
3 . The information may be snared witn o�.zer loca? , s�a�e or
f ederal agencies to the extent necessary to process tne pe?-mit or
?icense.
a. If your requested per•r.it or Iicense =ecuires Councii ac��o%
to ap�rove, some infoz-^tation may become public.
5 . You have certain rignts under M.S. 13. C? to rev_ew priva�e
data on yourself.
6. Your full name is required to process this application or
pe�-mit.
�� f7�) .�/�'��•rS C�Y� G'L�6�/�7rt Ci�-�
First Middle Las�
�_��7 U � /� �"l^� /�,�
Address
� ,
...Q i�r l-��.� ✓Yz ,'� ��-�� ��_��
Czty State Zip
� �� -� ���
Phone
I understand my rights as stated above.
_ �.. _
Sig�ature . �
Bll1LDING& ZOVI�G —473-7357 • AD,�IINISTRATION.4c FIVAVCE — 473-73_3 • PUBLIC IVORKS —4'3-7359
ASSESSIY G