HomeMy WebLinkAbout1995-006864 - re-side PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kel ley Parkway- P.O. Box 66 " ~ _ '�;;;=;
Crystal Bay, Minnesota 55323 Permit Number: ; _ :
(612) 473-7357 Date Issued: ,V;�_.�:•-,�-,r;,!_,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - F�����'_ °. _._..��� --
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APPLI NT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ ' ! Date Received:
Date Approved:
�; ,
Entered By: � ��' Permittt:�� ��' y
Ar•r• INgpRMATION MIIST BS SUBMITTED IN FIILL BEFORE PI�AN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
---------------------------
TgE APPLICANT IS: (circle one) O�dNER r CONTRACTOR
JOB SITE ADDRSSS: la.SC� I�r�ar c�� � ZIP: �!J �� �
(work)
NAME OF OWNER- ���l YYl U✓1 Gl � �a�.l ��✓�G 5�✓�� � PHONE: (home) `7`1 ��0 b ��
MAILING ADDRESS: �Z�U ,�r�u r 5 � • _ CITY: �4��/ Z� � ZIP: $�3`�/
CONTRACTOR: ���� pH��
MAILING ADDRESS: �L!'��V�--- CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PH���
MAII,ING ADDR.ESS:
CITY: ZIP:
N�ME. REGISTRATION n
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration_� Renovate Land Alteration
PROPOSED WORR (describe in detail) : (11L 1 i�t �n ��� ��'e�
A)1'V1�C�W I� ��L. � �1'( � �C-f`� � lv1�'���C �' �� SY1�C�l
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS:_� GAI2AGE STALLS: ATT. DET. Z
ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ �
��C��
I hereby apply for a building permit and I acknowiedge 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 accordance with the approved plan.
APPI�IC�NT'S SIGNATURE: G�/Yrt-f'�G�- DATE s 3��7^!S
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`��:���, C ITY of OI$ON
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:. t; 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 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:
l. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to suppl.y data, but refusal. may require that
the City deny the permit or license.
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 Councii ac�ior.
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 proc�ss this application or
permit.
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First Middl.e Las
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Address
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City State ZiP
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Phone
I understand my rights as stated above.
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gnature
BUILDING&ZONING—4�3•7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSING