HomeMy WebLinkAbout1994- 006006 - re-roof/tear-off PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: BUILDING006006
Orono, Minnesota 55356-0815 Date Issued:
(612) 473-7357 04/12/94
SITE ADDRESS:
?IO WAY7ATA BLVD
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P . I . N . : 24-118-?3-21-0002
DESCRIPTION: 3—d 00 5
RE-ROOF/TEAR-OFP
Buildinq PPrmit Type COM-ADD/REMODEL
Bui ] ding Work Type RF-ROOF
CITY OF ORONO
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04/12/9-
REMARKS:
FEE SUMMARY:
VALUATION $13, 000
Saqe F!r4e
4:144 . 00
Surcharge $E.,!=d2
Total Fee $1SO . S0
CONTRACTOR: — Applicant — OWNER:
DALBEC RCIO I NG: 14722080 WAR BILL
S42 01:,) nR 11AY7ATA BLVD
IONG LAKE MN 5b3S6 ORONO MN SS*:3SIS
(612) 473-2080
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS
SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF
L ORONO ORDINANCES AND STATE MINNESOTA BUILDING CODE REQUIREMENTS .
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APPLIC ERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $
/7�' Date Received:
Date Approved:
Entered By: Permit#: k%Cq
•
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
//��, ,�a/) � ALO ZIP: ..5.- --5-4s�
JOB SITE ADDRESS: �(�i • G�%
(work)
PHONE: (home)
NAME OF OWNER: 2,;./ 2.4.2
CITY: ZIP:
MAILING ADDRESS:
�� Z./-13- fO8D
��� PHONE:
CONTRACTOR: //
!Unn�/J CITY:G- &7f , ZIP: 6-----j-5-6MAILING ADDRESS: .� ��-2��J
STATE LICENSE:
PHONE:
ARCHITECT/ENGINEER:
CITY: ZIP:
MAILING ADDRESS:
REGISTRATION #
NAME:
Structure Move
TYPE OF WORK: New Addition Accessory Land Alteration
Demo Remodel/Alteration Renovate
PROPOSED WORK (describe in detail) : /2L .50 10,
STORIES: / SQ. Fi i OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding
land) : $ /3, a2y
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;
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: / 9 l--
APPLICANT'S SIGNATURE:,�Jait�..u�i ��'�,-/e-leZ:
CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
7 On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with 3 ,thatd. 2, "Rights of subjects of
your request for a permit or
data", we would like toinform you
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 permit or
federal agencies to the extent necessary to process ahe
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.
First
Middle Last
/553- 67e-01
Ad ass
rtz
Czty
State Zip
Phone
I understand my rights as stated above.
ignature /
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSING