HomeMy WebLinkAbout1993-005296 - 20 yds fill P�I�;�VIIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 t 1:=;L� [��"����[i
Orono, Minnesota 55356-0815 Permit Number: �_�`_}�.�,��
(612) 473-7357 Date Issued:
C��,/'�:;i'�:r:
SITE ADDRESS:
•�t r�;;�. �=;t 1c�(`-���;��i_��_�i� C`�t�2
L=��J
�'. � . t�. . =,�—�. �.;�:—�::=:—"=1-3:��:"�F_�:� �
DESCRIPTION:
��� 'r`Cj'�: �I L�
�1s�r F'�3'Fi77.�• Tyr�� L�it�J#? �L7Eht�TltiiV
;;I���' �� ���L',�'�
�it�Fn��4;�•i �+°�i i��
i'di7ttir'��'t!t�t �
1i:1JrtV1fVVV
i�� i[il rii 1 f�}
� VA VLl� JL�iLW
�'(�c!'� I} �JVtjlV
L•l7L4l� f+�
i1L!'C3l1�.-����f� �'�;;
ltL4+L1! t ! ! 7 VU
REMARKS: .,�r 1�=:,.• �i�• ;,t.. ,��•-;::
V4f�LVlf%J
FEE SUMMARY:
E�asw ��e __------��i3yc�i�;
�'�_tt.�cl ��� ��i�. i�Ci
CONTRACTOR: — r���=I i c���i. — `=;T . L I E_ .OWNER:
L�1P�—•��E--�:zwthu, 1_'I�C:. i�7�.'�'��.f; �,�:.F.�=`�.7�. F I L�t;F� F::Ej�(
�;�ik :.�;;; �tii��. �_;t!{,��F;i�l���i���3 t?�;
�k,�:�(,_:�;7 t�l�:' ��E!`a �S:_'=;1 i_fI�'�,'�_lP�E�i �'��� �?�:_;�,F,
�.��..:_.' . r -._.._� ..
T �:: € ::.� :- rt:.- -�ni:_ !:C_. _ ;� r.. ;t ' �`t"�_• —�,• _ ��;.� -:.i ,-:t y_; f_r �;. , ir...'{iC": �
���,_ _ar��st_r;._, f.i"��-__�.) : i��.�".��t ,'`-t`t;.,E„?a„>�`...� s _ {-''�:!"��1�.'._;;`._, f ._;l:. , �_! �":i—fe:,� �� ,�. �?`Y?�.._ .�.��;'�'i_14 r_; .,,:tf�`._�
��s'�'�-31=��.+.�� <I�'�f�' t�`�lr'';'ij�`_� ';iw. if i ']` i E� j_I'•z'i-:: i tt! �s j t�' i�';_i;. ��I .�;�';- ; T ' {�' — j i
_ L _ f L_ 4' . _�� _�I _ - �}� ._ii--i�',�• :+�_�'� t-�L' �1 'iY .:{�
{ [- .t t•. i�:�i_`� F i[y -( (� _ . . _ -�`;'-: �T i i { ��r :`' F t"-r�-•
L xiC:�t.l1��..I _, 1.7 i+.�f�f'v,�j,,.��'• rj��t�t. �_.i�i-.�i� i���"' i'i�(:`�'.:S"'_�,�#�. p ,i-�i }';'�.�._»LrJ,�V�i ._.�_��t�', f'tr-._.�� 1.�[i^�:�Il§ F .� , �
l
APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
/ /�
CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ J � • � Date Received:
Date Approved:
Entered By: /j permit�: J��'t �
ALL INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
-------------------------
THE APPLICANT IS: (circle one) OWNER or TRACTO
JO$ SITE ADDRSSS: 2�0�" S(���V' 1���'S �Y'. Z1P: �� ��'�O
(work) " 7��
NAI�: OF OWNER: � � Vt/�-� PHONE: (home) �'I�"�7Z7
MAILING ADDRESS: � �L�r WBD 5 r1'�,CITY: O�'O�O ZIP: �7��0
CONTRACTOR: ��-�I�1 � ��i '��N �-`�' PHONE: � 1�' ��O
MAII.ZNG ADDRESS: �O• 1�6� ��� cITY: �-��=�,l�S�f�__ Z1P: G.���1
STATE LICENSE: # �.C��iU �7�
ARCHITECT/ENGINEER: ��N` IC G- �U� �`�� PHONE: �7�� ��d
MAILING ADDRESS: � O< < CITY: ���.��J��' ZIP: ��7�JI
N�: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure Move �
Demo Remodel/Alteration Renovate Land Alteration�
PROPOSED WORR (describe in detail) : , J� � � � � S ,
(� �( r �
3✓r/�� K r '
STORIES:_______ S4- �T OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding 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. •
�� ��l � �� DATE: D `� � //
APpLICANT'S SIGNATURE: �
�5-
� .
�
CITY of OR�NO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
• � • • On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "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: , , .
1. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to suppl.y data, bi�t refusal may require that
the City deny the permit or license. ,
3. The information may be shared with other Iocal , s�ate ar .
. federal agencies to the extent necessary t�o process the permit or
license.
4. If your requested pe�mit or Iicense �requires Councii act�on
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your ful.l name is required to process this appZication or
permit.
� �L��l� t�� G��� �1��_ .
FirSt Middle Last
—1 • �' �x ��� � �� ��Z`�if �' I W 1G[/�I/ �Y Fi.
Address
. ���s� �� ��3�
City State Zip
���-- 2�C�
Phone
I understand my ri hts as stated above.
Signatu e
BUILDING&ZONING—473-7357 • ADMINISTRAT'ION&FINANCE—�t73J358 • PUBLIC WORKS—473-7359
ASSESSING