HomeMy WebLinkAbout1994-006449 - culvert/fill PER���'�
CITY OF ORONO PERMIT TYPE: __ _ .
2750 Kelley Parkway- P.O. Box 66 ��-�= `��'
Permit Number: " � �` s�� �-F`�,=L`.
Crystal Bay, Minnesota 55323 '_'°;-'f='�,t�='
(612)473-7357 Date Issued: t„� ::;�� ;�:r
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SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: O:WN��Ri��, — r'�-$�i �.������t. —
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO - BIIII�DI2v� PER�iIT APPI�IC�TION
� Date Received: '�/�� `fi `�
Total Fee: $ -
Date A��rove�: '
Entered Bv: Per_nit� - _=
AT•T• INgpRMATION MIIST BS SUBMITTF.D IN FDLL B�'�� P�N �vl� � BE Sg���
(See Check-off List Encl.osed)
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�� �PLIC�JT Ig: (circle one) OS�TNE� or CONT_4.ACTOR
. .�s�'35.�.
JOB SITE ADDRBSS: /5 .� ' �, /)• /f�� /�-�1 Z p `L��
(work) `f7s�� � ,-
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i�(:�1�� ��"n��� PHONE: (home)
NAME OF OWNF.R= �i� �i �, �'� -
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MATzzxc r�n�ss: !S?� � ��. /���-v� n-� _ cz�._� �
� PHONE: �t%'! �E —
CONTRACTOR: ��l�'"'
��: ZIP:
j�p,TT ING ADDRESS: �'"� �,�����'
STATE LSC...�NSE: T
PHONE:
ARCHZTECT/ENGINEER:
CITY: ZIP:
MASI.iNG ADDR.ESS:
REGISTRATION �
x�:
Accessory Structure Move
TYPE OF WORR: New Addition Land Alteration_�'
De�o
R�*nodel/Alteration Renovate
-L�cei;-,��� �
o -� l_.tt�G'�r�� Cl�i,��''
PROPOS�D WORK (describe in detail) = �" _
`� �
�� `'�, -�G _' �- � ' -
�tJ ,/,. l �/- /rc -
6�-� � ��
STORIES- SQ. FEET OF �� �'�R'
I�7�_ OF BEDROOMS: Gr�GE STAI�LS= ATT. DET.
EST2MATED CDNSTRIICTION VALIIATSON (eacludi.ng
i�a) : S '`�, oob ��.`�;.n,'`�
I hereby applY for a building permit and I acknowleaae that the information
- that the work wi11 be in confo� Code;� th the
above is complete and accurate, and with the State Building e�it; and
ordinances and codes of the City
understand this is not a perntit and work is not to start without a p
that the work wi11 be in accordance with the approved PI�- s
____ _ .,• �� `t
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� � DATE: ��.�*�'
APPLICANT'S SIGIZATDRE z�%� � ` �
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Post Office Box 66`CrYstal Bay.Min�esota 5a323•Municipal Offices
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On the North Shore of Lake Minneton a
• ' � •
DATA PRSVACY AD�SORY
Subd. 2, "Rights of subjects of
2n accordance with M.S. 13•ou�that your request for a perm ui�e
data", we would like to inform y o f its departments may req
license from the City o� Orono or any
you to furnish certain private or confidential insormation.
You are notified that:
�, The in�ormation you furnish will be used to determine your
cualif-cation for the pe�i� or license requested.
2. You may refuse to supply data, but refusal may require that
tne City deny the permit or license.
be snared w�th other Iocal , s�ate or
3. The information may rocess the permit or
federa� agencies to the extent necessary to p
license. . �
your reauested Pe�=-t
or iice*�se -eQuirPs Cou�cli ac��o%
�. Li L become public.
to aporove, some in=orma�ion may �
J •
You have certain rights under M.S. 13.Oa to review pr�.va..e
data on yourselr. y ,
� �ss th�s 3DD1-�ca �-'-on or
6 . Your full name is required �.o proc_
pe�it.
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Phone
I understand my rights as stated above.
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BUILDING&ZONING—473-�357 + ADMINtSTRATtON&FINANCE—473-7358
• PUBLIC WORKS —473-7359 •
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