HomeMy WebLinkAbout1991-003682 - re-roof/tear-off PERMIT �
� ��, OF ORONO PERMIT TYPE: �;��I��,i�,��
� �rown Rd. South • P.O. Box 66 Permit Number: t it a_:i=�c;���
�rystal Bay, Minnesota 55323 Datelssued: {i�a f�ji'��.
(612) 473-7357
SITE ADDRESS:
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APPLICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE
� �y CITY OF OROZiO - BIIILDING PERMIT APPLICATIOI�i
.
Total Fee: $ Date Received:
Date Approved:
Entered By: Q
Permit#: ��U�''`
ALL INFORMATION MOST BE SOBIrIITTED IN FIILL BBFOR$ PLAN REVIEW WILL BE STARZ'ED
--------------------------------------------------------------------------------
TH$ APPLICANT IS: (circle one) OWNER or CONTRACTOR
� �
JOB SITE ADDRESS: � ��/� STUf��S f��i� �� ZIP:
(work) y7�'���-
NA�: OF OWNER: (��r 7 /�✓'��� PHONE: (h ome)
MAILING ADDRESS: S�q-ivt� CITY: La`'`,5 �� ZIP:
CONTRACTOR: �(� �-I�����`�-✓ PHONE: �S7� -27 7/
MAILING ADDRESS: �,����G 3bg � CITY: MaN.�c.��(v ZIP: �'S36 'Z_-
TYPB OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : �P�y,o✓e d/✓ ��.�f_� D/��t
STORIES:� SQ. FEET OF EACH FLOOR: �,3�`�
NO. OF BSDROOMS: GARAG$ STALLS: ATT. DET.
$STIMATSD CONSTRDCTION VALIIATION (excluding land) : $ a,�bad
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 Fermit and work is not to start without a permit; and
that the work will be in accordance with the approved p lan.
APPLICANT'S SIGNATURE: • �p " ��
�(,t��c( ��� DATE. �
tPlease fill out the reverse side of this form)
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal O�cea
•
� _ � � On the North Shore of Lake Minnetonka
D�A PRIVACY ADV��OR� '
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 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:
l. The information you furnish will be used to determine your
� qualification for the permit or Iicense 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 information 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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Address
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City State Z1p
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Phone .
I understand my rights as stated above.
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Signa ure
BUILD[NG&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 . • PUBLIC WORKS-473-7359
A3SESSING