HomeMy WebLinkAbout1995 - 007200 - tear-off/re-roof PE IT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway P.O. Box 66 Permit Number: qI T `'
Crystal Bay, Minnesota 55323 is v i t__i
(612)473-7357 Date Issued: 'oist /9�;
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SITE ADDRESS:
450 3 f 1
RD
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DESCRIPTION:
- -: -' /R -; tO:
rU. Esl...i? �#` Permit l`r` 'e _ ;il.f � L`-;#W# fyE
.».u_. .E.ding WorkTypeRE—ROOF
CITY T! Vl ORONO
i dAY'L OFFICE
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REMARKS:
FEE SUMMARY:
VAI__JA-If N ';_::_
B_. _a t=ee $162 .25—
h $ (7
-!f_staS a ._ ...7 . .�'
CONTRACTOR: — App l i c an t• - •ST . LIC . OWNER:
-:_art I�.`• E !j P;:i•' i S'•'L'_ E % �iG � .`-7t=, f w I`v DAVID
s
450 WOOnH I LI. RD
:3:3115
M 1 NNEAP01 T'ry: #'i± -,.;.R.'„ :, 2; �;#�i4:3#M# I'�j.f 55391
(612) 729-4420
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APPI Ir.ANT/PFRAMTPF SJ(;NATI IRF IGSI IFfI RV ! I(;NATI IRF
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: Permit#: 2 AG 0
ALL INFORMATION MUST BE SUBMITTED Check-off FULL BEFOORse
Ed N VIEW WILL BE STARTED
(See
THE APPLICANT IS: (circle one) ,`OWNER or CONTRACTOR
JOB SITE ADDRESS: 4 SD 'V"`1Dob14I LA.-- 10 ZIP:
(work)
NAME OF OWNER: 'DA V /0 N ) L---SD i) PHONE: (home)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: /0 �H - 10A'J P .S�i, PHONE: :47.9-
4 7 44 Z
MAILING ADDRESS: S a4 l ST IVF 5 CITY: flu J POL 5 ZIP: S 06
STATE LICENSE: # 59 3-
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORK (describe in detail) : 1-FA or---F- et. ( f /,) 74-0 0
I, ,g r t . i L_I••6 :•
-
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 10 08C)
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 acordance with the approved plan.
APPLICANT'S SIGNATURE: iil"�
f�� � a , / DATE: �f IN/ `7c---
• 7.
CITY of ORONO
C� 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 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
he permit or
federal agencies to the extent necessary to process
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. / �!�
PAlft-- 4- 5C( LJ1 V 2�P `C�"o•�- E 0 f-ki i )
First Middle Last
334-&
Address
W1 I0FA-001--1 S� M/d
City State
-
Phone
I unde stand my rights as stated above.
/, , 6.
, i , ,
,
4 ,
Si.na ure ��
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING