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Home My WebLink About1995-007396 - tear-off/remodel PERMIT CITY OF ORONO PERMIT TYPE: 2750 Kelley Parkway- P.O. Box 66 Crystal Bay, Minnesota 55323 Permit Number.- (612) 473-7357 Date Issued.- SITE ADDRESS: k DESCRIPTION: I FT P H Ty p TT'1• r- Ili. 1 1� LAc L"ROrlyc' �Hr" 1'fHRL-Z- u)rr 1 11, i A.1 A 17).1i J1 Vvvvv # 1 75 A e-,Lf-f-vvyvv V1I i"cid - - ZC V1 1.7LIT AI Tf iSLi-`L77:-, #,746-39VO L�`�Ov`l irit"I I REMARKS: FEE SUMMARY: -j CONTRACTOR: U1:.zC'f`jj OWNER: -f -j-7 4 1 i I T i in 1) —1 j! ST THE UNDER LGNED HME-REBY REQUESTS PERMISSION TO MAKE $THE REAL IMPROVEMENTS T SPEC IF T'ED AND AGREES TO DO ALL WORK ..N STRICT COMPLIANCE WITH ,ALL, CITY OF ORDINANCE'.3 AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. L APPLICANT/PERMITEE SIGNATURE( ISSUED BY:SIGNATURE CITY OF ORONO - BUILDING PERMIT APPLICATION Total Fee: $ Date Received: Date Approved: Entered By: Permit#: 3,�(0 ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED (See Check-off List Enclosed) ------------------ ------------------------------- --- --------------------- 4�� - THE APPLICANT IS: (circle one) OWNER JOB SITE ADDRESS: ��© � - xO ZIP: (work). NAME OF OWNER: �k.�C� ��`4P� PHONE: (home) MAILING ADDRESS: (D L7 �L��Lo�r-. -�-- CITY:0[C7 (\C� ZIP: CONTRACTOR:�r,p,),O Cly Q �C� 'n^ PHONE: as ` MAILING ADDRESS:�_c,Sfvo Q'S CITY,: 1 t ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION # TYPE OF WORK: New Addition Accessory Structure Move Demo Remodel/Alteration Renovate Land Alteration PROPOSED WORK (describe in detail) : l C�,Q�SP��apa STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ a, 4q 12 I hereby apply for a building permit and I acknowledge that the informatio above is complete and accurate; that the work will be in conformance with th ordinances and codes of the City and with the State Building Code; that understand this is not a permit and work is not to start without a permit; an that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: \/. DATE: l -Z�� CITY of ORONO Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices • On the North Shore of Lake Minnetonka ORONa 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 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. 13.04 to review private data on yourself. 6. Your full name is required to process this application or permit. ear Obi n4 First Middle U JLast ,;;)---30q Address ity State Zip Baa 711 Phone I understand my rights as stated above. Signature BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 ASSESSING