HomeMy WebLinkAbout1993- 005782 - install drain tile P1RMIT
CITY OF ORONO PERMIT TYPE:
2750 KelleyParkwayP.O. Box 815 U!:;E ti OFF I )
Permit Number: Vis,;,_7'=;y
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: i 1/29/93
SITE ADDRESS:
2160 0 W,;f Y; ,:T,c BLVD
Ski
DESCRIPTION:
INSTALL AL! I'.)I-AI.N TILE
User Permit Type LAND ALTERATION
i:i i
•"I;t !ilii s`d
J.+J J.i'v'L�VVVV !!
01 VENT 0•00
CHECK i '1 00
.LLr! THANK
r ifti
R'i!lii.L 1.VV1 !\1!1 !11•V!
'+ T . -o i tl.'
REMARKS:
FEE SUMMARY:
Base Fee s!;0_00
Total Fee $S0. 00
CONTRACTOR: OWNER: - i;ppI c: nt. -
��J��-R W,T,_- AM
2160 WAYZATA BLVD
ORONOMN 53:.5 ,
THE UNDERSIGNED HEREE Y REQUESTS P'E RM I SS I I_:iN TO MAKE THE REAL IMPROVEMENTS
SPECIFIED AND AGREES Ti:i DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY O=L
ORONO URLINTN .:ES AND TATE -;F MINNESOTA BUILDING CODE REQUIREMENTS .
�— ._J
(.1/4.42)
APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ ) �j` t Date Received:
Date Approved:
Entered By:
Permit#: 5-71-2"
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
ThE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: c/(v D ZIP:
(work) -I/7k
NAME OF OWNER: //3,4:--6, Y PHONE: (home) -/7.3-
MAILING ADDRESS: ;:: r./A-K3d 6 ZIP:
CONTRACTOR: � PHONE:
MAILING ADDRESS: S/ CITY: 0'7-4� ti ,_-L. ZIP:
'?s
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
PROPOS= WORK (describe in detail) : /�,._:Ze
--T
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding 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.
DATE: /7- ,�
APPLICANT'S SIGNATURE:
� R
CITY of ORONO
C�ZIt :
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
OF-
-.ORONO' 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 confidential departmentsayrequire
you to furnish certain private
You are notified that:
1. The information hey° nish will or licensebe used to requested, determine your
a
qulification Permit
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 requ isted formationtmoray become publicense gic uirres Council action
to approve, some
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.
First
Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature
BUILDING&ZONING—473-7357
• ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359
ASSESSING