HomeMy WebLinkAbout1991-003767 - re-side & overhang t • , F PERMIT
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QTY O ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit
Permit Number:
Crystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357
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SITE ADDRESS:
:372S TOUT RD
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P. 1 .N. ; 17-117-23-31--0017
DESCRIPTION: i
RE-SIDE & OVERHANG �
Building Permit Type SF-ADD/REMODEL
Building Wart; ,Type; RE-SIDE
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REMARKS:
FEE SUMMARY:
VALt ATI +! 4600
Erase Fee $17.00
Surcharge 1-1;.Q
Total Fee $17 . SCS
CONTRACTOR: OWNER: -- Applicant
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DARTH -JOHN
372-S TOGO RD
WAYZATA MN 55:31� 1
471-5175
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
ALL INFORMATION MOST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
----------------------------------------------------------------------L----------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: -5 72 ZIP: 1
(work)
NAME OF OWNER: Jc)
PHONE: (home) V7/-9 17S
MAILING ADDRESS: �7 2 S— fO ZIP: S'S
CONTRACTOR: je '' `^ � PHONE: q 71" 41/ 75
MAILING ADDRESS: �72� 0C��7 fif4CITY: D & 1JC) ZIP:
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORK (describe in detail) : �'C' I� �C
STORIES:_ SQ. FEET OF EACH FLOOR: d C)
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 6o o , co
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.
APPLICANT'S SIGNATURE: DATE:
(Please ill ut the reverse side of this form)
-044
CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� On the North Shore of Lake Minnetonka
TA-PR
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:
1. The information you furnish will be used to determine your
qualification for the permit or license 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.
- -
-
First Middle Last
Address
Cit -- -- - - State Zip
Phone
I understand my rights as stated above.
Signatu e
BUILDING&ZONING-473.7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING