HomeMy WebLinkAbout1994-006198 - add/remodel PERIliIIT .
� C�TY OF ORONO PERMIT TYPE: r
2750 Kelley Parkway • P.O. Box 815 �.:�t I�C};��i�
Orono, Minnesota 55356-0815 Permit Number: ;_,��;_,: =a;_;
(612) 473-7357 Date Issued: � : :,i
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SITE ADDRESS:
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CONTRACTOR: �— �� - ' � " -�� � �-� OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �
� ' y CITY OF ORONO - BIIILDING PERMIT APPZIC�T��N
� Date Received:
Total Fee: $ -
Date A�nroved: '
Bntered Bv: Fer.nit�: � - __ .
TION MIIST BS SUBMIT�ED IP7 FL7LZ B��� P�N �vl� �I'I' BE S�`�RTFJ�
AT.T• INFORMA (Se� Check-off List Enclosed)
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_ ------------(circle one) Oi�T�IER CONTQACTOR��
THE APPI,ICA21T I5: ----
.'- � y �:- ZIP s
JOB SITE ADDRSSS: _ � `� '
(work)
� � l P30NE: (home)
NAME OF OWN�= � � ! F `'" /<< iti��%�
CITY: ZIP:
2�AII.ING ADDRESS- ,
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� �' , � PHONE s �l �/ _. `��.L�
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CON�RACTOR: -n �-j ' � C- CSTY: /��-,�.1`= �I ZIP: �: '� �:��' ��
MAT_T ING ADDRESS_ `��/�� ,�.� � r,`: ' {
STAZ�E I,IC.�NSE: T `7 �/J�
PHONE=
ARCHI'I'�'CT/ENGINEER:
C=�: ZIP:
MATZING ADDRESS:
REGISTFtATZON �
NAME:
Accessory Structure Move �
TYPE OF WORKs New Addition Land Alteration
Demo Re.*nodel/Alteration
Renovate
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PROPOS� WORK (describe in detail) :
��� �;���. �
STORSESs S4• FEET OF EACH FLDOR.
��� gTAT,T•g: ATT. DET.
NO. OF BEDROOMS: _
c��-.
� I.and) : $ _-���C��'' — �
ESTI�SA�F.D CDNSTRUCTION VALt7ATSON (eaclndinq
hereb apply for a building permit and I ac�cnowiedge that the info�ation
I Y that the wor!c wi11 be in conform Code �'''ithathS
above is complete and accurate; and with the State Building e�it; and
ordinances and codes of the City
understand this is not a permit and work is not to start without a p
that the wor}c will be in accordarice witiz the apprvved pl.au. •
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; �� / �_--� DATE s l< ` � �
APPIrICANT'S SIG2IATORE s /`
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�- � � � ���'� o� ��.��.�aT�
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Post Office Box 66•Cr5'stal Bay,Minaesota 5�323•Municipal Offices
� _
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On the IVorth Shore of Lake Minneton a
DATA PRS�ACY ��SORY
"Ri hts of subjects of
9 Y
2n accordance with M.S. 13• ou'thatdyour request for a P=quire
data" , we wou3.d like to inform y of its depar��ents may
;�.cense from the City o= Orono or anY � � n=o�ation.
you to furnish certain private or confident_al
�ou are notified tnat:
T w�IZ be used to dete'-"mine your
1. m�e inTormation you fu_nisn
cuali�icat'on for the perni� or license requested-
2. You may reruse to supply
data, but re=usa1 may require that
the City deny the pe�i� ar license.
be snared witn otZer Iocal , s�a�e er
3 . The information may o roc�ss the pe'-"mi� ci
f ederal agencies to the extent nec�ssary to P y
license. ,
yo pe�ait or IiC8RS2 reauyTes Counc�I. a��=or
a. �f your recues`..d � become public.
to approve, some in=ormat.�on �ay
5 . You have certain rights under M.S. 13.Oa to review griva�e
data on yourself.
6 . Your fulZ name is recuired to procsss this application or
pe�it.
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Phone
I understand my rights as stated above.
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Signature
3UILDtNC&ZONING-473-7357 • ADMINiSTRATION&FIN.�NCE-;73-7358
• PUBLIC WORKS-473-7359
�SSESSING