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HomeMy WebLinkAbout1992 - 004670 - land alteration PERMIT CITY OF ORONO PERMIT TYPE: S DEFINED 1335 Brown Rd. South • P.O. Box 66 Permit Number: t tt 4.h,•• - Crystal Bay, Minnesota 55323 Date Issued: 09/29, '� (612) 473-7357 SITE ADDRESS: 0 t WOODH}ISH I LL RD JB P'. I .N. : 02-117-23-12-i jf ti t 1 DESCRIPTION: User Permit Type LAND ALTERATION .1.3.1j-7. J1J7. c.0 00 V 01 CHECKf L 350.0 #254240 VVVl It l LL 1�•�( • Vt IL1 lL REMARKS: FEE SUMMARY: VALUATION 1 ,ittt0 Base Fee $75 .00 It►vest.i9t•i+��tl7� tt{'? To .- i Fee 50 0() t� $1 - - • - - 1 CONTRACTOR: Oyl(NER: - AYP�I i c it - w ii RILL COUNTRY CLUB -...00 Wi ii SDH ILL AVE WAY ATA MN 55.3:i' 1 473-5311 re , l�Zfir �` '''''.1:'',11; 'MTM£ � r�a"y SCM r u� Z v; v lad i, ' �' rate g �,-,,,Ni,,„,„;,,,,,,, t ,\:n1k 't� . ' ;. : e ^w E x e 4x rt,64",e4 ' ',‘64M',"!t"':-66'' , Er Lia .r� .. .�� vq'���` iw t '�k' ,� ¢w^ ��f �,�,� � ,x�:s, ,m�rew� ���.�� �,„gin: � � � a ii j,�';:. ,, � � �� APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE 1 CITY OF ORONO - BUILDING PERMIT APPLICATION Total Fee: $ Date Received: Date Approved: Entered Bv: Permit ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED (See Check-off List Enclosed) `:NE APPLICANT IS: (circle one) OWNER or CONTRACTOR 0r Pool0B SITE ADDRESS: �, ©O l-�t')t'? t l Q ZIP: 3-1/45-LO (work) F OWNER: � ,@C_��i ' � © �' PHONE: (home) NAME O C'� �1 Cf q MAILING ADDRESS: CD* ��►� I ,CITY: L(�. y '(ick O. ZIP: 15-3 / d CONTRACTOR: PHONE: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: po T612_0.,.. 4m4i; ._L oa c, PHONE: 7 )3 . c%/ Y/ aRCHITECT/ENGINEER: C� i •v � � / Art l MAILING ADDRESS: Vc�c Y ac .c.ePcd�J�. CITY: LO-.a LLQ ZIP: Ss�� NAME: mav 2®«� E'cEcj REGISTRATION # TYRE OF WORK: New Addition Accessory Structure Move • Demo Remodel/Alteration Renovate Land Alteration y� PROPOSED WORK (describe in detail) : ;TORIES: SQ. FEET OF EACH FLOOR: AVO_ OF BEDROOMS: GARAGE STALLS: ATT. DET. E'STIMA'TED CONSTRUCTION VALUATION (excluding land) : $ 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 ':nderstand 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 c .c./14P 1.PPLICANT'S SIGNATURE' I • JL CITY of ORONO ,s,..„-„,,,,,,, ,,,,,,,, ,,,,,, 4,-,-,4,-„....:.--...„•-'-`= c Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices -XIEECIffitt 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 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. 6(')ic-Lk02 6:C)KZL / • First Middle Last Q 0 9 3 )1 , Cs o.d A 0 .- Address L0 . L4 e , rh Sj3" 6 City() State Zip 4/ .7.5---/ ,7s/ Phone I understand my rights as stated above. I , �.r ,/ Signature •• BUILDING& ZONING - 473-7357 • ADMINISTRATION& FINANCE - 473-73_3 • PUBLIC WORKS - 473-7359 ASSESSING