HomeMy WebLinkAbout1993-005213 - hot tar roof PERMIT
C F ORONO PERMIT TYPE: BUILDING
2750 Kelley Parkway + P.O. Box 815 Permit Number: 60-5213
1521 ;
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: 06/023/93
SITE ADDRESS:
1000}lam}0 WILLOW DR
CH
P . I .N. ; 10-117-23-21-0004
004
DESCRIPTION:
HOT TAR ROOF
Building Permit. Type SF-ADD/REMODEL
Building Work Type RE-ROOF
REMARKS:
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FEE SUMMARY:
VALUATION $10,000 IV
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Base Fee $117 .00 01 &EN .=i.vii//��
Surcharge $5.0 ? i:�'iti��'irS #�
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Total Fee $239.00 LqL4PX TL Ci9�j
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CONTRACTOR- - Applicant - p+t _FiRNER
SAI C 0N.S'TR�1C'i ION INC1'+290780 R : PHILIP
6.501 CAMBRIDGE ST 1000)0t 3 WILLOW DR
'=T . LOUIS PARK MN 554':16 ORONi� MN 55391
(612) 929-078.0
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ,��
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered B f`i/
y' Permit n:
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: ( b�D CTTo,Z " ZIP: ��
(work)
NAME OF OWNER: - �v PHONE: (home)
MAILING ADDRESS: O �J CITY: (5gzaYL , ZIP: -S-3
. nn moo?f,X80
CONTRACTOR: �l ( � PHONE:
MAILING ADDRESS: CITY: J( �CTu"° IP: 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
ED WORK (describe in detail) : j �-
PROPOS '
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 permit and work is not to start without a permit; and
that the work will be i ccordance wi the approved plan.
APPLICANT'S SIGNATURE.
DATE:
J�
E CITY of ORONO
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
- 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.
'V
First Middle Last
Address
UA01,v � 5- 3
City State Zip
4f2 �20�
Phe
I un rstand my r' ht a stated ;ab7o e.
Sig ature
BUILDING&ZONING—473-7357 • ADMINISTRATIO FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING