HomeMy WebLinkAbout1993-005504 (building- re-roof) PF,I�MIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: `�E.';f..``�;:�{.�
Orono, Minnesota 55356-0815 Date Issued: "'-'�''t':}
(612) 473-7357 s`:,�;;� :=;;:��;:;
SITE ADDRESS:
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DESCRIPTION:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT A.PPLICATION
Total Fee: $ ,� � r�� Date Received:
� Date Approved:
,
Entered By: � � i�� permit 7: ��� 'f
AL_L INFORMATION MIIST B$ SIIBMITTED IN FIILL BEFORE PLAN RE�7IEW WII,L BE STARTED
(See Check-off List Enclosed)
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TgE APPLICANT IS: (circle one) OLdNER o CONTRACTO
JOB SITE ADDR.$SS: �� O'� I C1L�C� l��-__ ZIP:
(work)
NAME OF OWNER: �,� � �' �Y PHONE: (home)
MATLING ADDRESS: ��� 1 ���L� � CITY: ;�(A-�ZCh�� ZIP:
� � PHONE: �t � -\ � � C"1 � �'�
CONTRACTOR: ��.x.����� �--x � `
MAILING ADDRESS_ C�yC�� t�`G � 2 CITY:��(S�(���-PIZC,'��"� ZIP: �'� �S �
STATE LICENSE: # -I� � !
ARCHITECT/ENGINEER: PH���
MAILING ADDRESS: CSTY: ZIP:
N��_ REGISTRATION tt
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : r--
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c;�-� cE.d�� ' I �� {�-� c� �e� C� eu�� =�Pp�t � ����
STORIES: SQ. FEET OF EACH FLdOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) s $ � r C� � �
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 accordance with t/he approved plan. �
�'�✓�� DATE: ���j�-�7_�
APPLIC.ANT'S SIGNATURE:
a �
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� CITY o� OR�NO
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- Od Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� _ � � On the North Shore of Lake Minnetonka
DATA PRNACY 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
Iicense 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 wil.I be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other Iocal , s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Councii. ac��or_
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 ful.I name is required to proc�ss this application or
permit.
�C�,C. I � � LJ�-1�5� �
�d��"T �(. I\f'�
First
Middl.e Last
i �
'��� i �
Address
'�(�i��e ����`�� I�.l� �� � � �1
City + State Zip
`-1� � �� � f � �
Phone
I understand my rights as stated above.
�,�i�/� ",�2-9�`--
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSING