HomeMy WebLinkAboutBuilding Permit Application 1987 Date Received: 1" 4
' Date Approved:
Permit#: Project#:
Building Permit Application Requirements:
1. Building permit application - to be filled out completely and signed
2. 2 sets of construction plans to include the following:
a) Floor plans;
b) Footing and foundation plan;
c) Elevations (of all sides) ;
d) Wall sections and cross sections;
e) Details - stairs and any special connections.
3. Certificate of survey with location of existing and proposed
structures including hardcover calculations and grading and drainage
plans as required.
4. Energy calculations - form provided.
5. Septic report and design if required.
ABOVE INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
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THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: 3S05 (L.�Pt Z4"-M zip:.
PROPERTY IDENTIFICATION NO. : 3 c'� - I I -c�3 13 Oco
(work)
NAME OF OWNER: T- PHONE: (home)A`1(o- i3Z�
MAILING ADDRESS: 35O�S �� j�.��.1p CITY:
CONTRACTOR: ss - PHONE: A-X-6-A0ZCo
MAILING ADDRESS: CITY: ZIP:
ARCHITECT:k, � �C�.wlfd-�,� 5'�'tf3 I7� S PHONE:
MAILING ADDRESS: Q.,1J} '�j �j C�, CITY: Q �1��� ZIP: 5�3�°I
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate'
PROPOSED USE (describe in detail) : �X1��1►JC� _ i '�(aQs�c.Jy 1� r3 �-..! F �
STORIES:_ SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: Ofd GARAGE STALLS: ATT.4Rr. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ i�-, �•�
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 accordancewiththe approved plan. \
APPLICANT'S SIGNATURE: _ Ol.car---s-�!! If — DATE: 1Cc I��ItI IM
(Please fill out the reverse side of this form)
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DATA PRIVACY ADVISORY +
In accordance with M.S . 15 . 165 , "Rights of subjects of data" , 1
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 inform- '
ation.
You are notified that:
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1 . The information you furnish will be used to determine
your qualification for the permit or license requested . j
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 certian 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
` � t M\
�►�Co- '13z�
Phone
Z understand my rights as stated above .
X � t,
Signature
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