HomeMy WebLinkAbout1992-004565 (Re-roof) = � PERMIT
~ CI�� �� O�O�O PERMIT TYPE:
k 1335 Brown Rd. South • P.O. Box 66 E�11 I L�T i�Ci
Permit Number: tft��.�,�.5 �
Crystal Bay, Minnesota 55323 Datelssued: t�;;:/�,�/'�y
(612) 473-7357 �
SITE ADDRESS: I
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DESCRIPTION:
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REMARKS:
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APPLICANT/PERMITEE SIGNAT E ISSUED BY:SIGNATUR�
�
• CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $�� (o'� Date Received:
Date Approved:
Entered By:�l'�✓ . �e�mit�: �l�� 5'
AT•T• INFORMATION MIIST BS SIIBMITTED IN FIILL BEFORE LAIJ REVIEFI WII'I' B$ STARTED
(See Check-aff List Enclos�d)
THE APPLICANT IS: (circle one) OWNER ar CONTRA�TOR
Jos sz� Ann�ass: � ��J l-��' ��S 5� v e e� zzP: Ss� 3�
(work)
NAHII: OF OWNER: �e"� � �r��S�l�a �� PHONE: (home) �4�-`TC1��
MAILING ADDRESS: Sa�v�e a 5 �1/x��@ CITY: � J'��� ca ZIP: ��L/��
corrrx.Ac�roR: �'�v� C c�� � ' �v'ev+�l� ��c�`� :�c� paorrE: '�"z2� /��
1KAII.ING ADDRESS: a�j O� �7�e � ��+n at fFV •SCITY: � I� � � Z IP: S S- �O�/
STATS LICENSE s #�� 1 LI�•� i,
ARCHITECT/ENGINEER:
�8 t� � � PHONE:
MATLING ADDRESS: CITY: '' ZIP:
NAME: REGIST'J,2ATION �
TYPE OF WORR: New Addition Accessory Structure Move �
Demo Remodel/Alteration�_ Renovate Land Alteration
PROPOSED WORR (descri.be in detail) : �2 �f'oo� �1 a� ���� � ��'`r
�n� �v�.�Y`
STORIES: r SQ. FEET OF EACH FLO�Rs
NO. OF BBDROOMS: GARAGE STALLS: ATT. 'IDET.
- e�
ESTIMATED CONSTRIICTION VALIIATION (escluding I.and) $ $ 1�l
I hereby apply for a building permit and I ack�j awledge that the information
abone is complete and accurate; that the work willl 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 t�o start without a permit; and
that the work wil 1 be in accordance with the appr�ved plan. •
APPLICANT'S SIGNATURL: �D� �' ` DATE: � ")�'�_
�
�
(�I'��'o� O1�01\TO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
0
s ' s e 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 Iike 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 I.icense.
3. The information may be shared with other local, s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council act�on
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.
1t� o��f' \ �a`v' � � �l���� � ��C�"�
First Middl.e Last
30� 3 �is�� �4 � . �-
Address
�� A �v 7p ` �S ��/� �S ���
City State Zlp
`72�—�c��r1
Phone
I understand my rights as stated above.
!�/\���' e
Signature . .
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING