HomeMy WebLinkAbout1993-005106 - re-roof/re-side -
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CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 �='`-'��=-`-'����'
Orono, Minnesota 55356-0815 Permit Number: ;_k�_:�s���.,
(612) 473-7357 Date Issued: :;c,;�t r;�;�_�;:_;
SITE ADDRESS:
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IC NT/PERMITEE SIGNA E ISSUED BY:SIGNATURE ���� \
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CITY OF ORONO - BIIILDING PERMIT APPLICATION
�// �,�, Date Received: ��y" �-3
Total Fee: $ / `���
Date Aporoved:
Entered By: ,�,A� permit tt: `' �d �
AT•T. INFORMATION MIIST BS SIIBMITTED IN FULL BEFORE PI+AN REVI� �I'I' B$ STARTED
(See Check-off List Enclosed)
------------
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TgE APpLICANT IS: (circle one) O�dNER or�CONTRACTO� c
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Ci /'�✓1�- � ZIP: �� �
JOB SITE ADDRSSS: � �� �--r" �� "" -
(work)
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f � ��,� �� '� PHONE: (h ome) `1 �� �7 � `
NAME OF OWNER: �J
MAILING ADDRESS: x'�""`�- CITY:
ZIP:
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CONTRAC'rOR: �� /J
C�U-' PH�NE: t'l �7 C `- �- S �
MAILING ADDRESS: ` ��/�; ,�., �-�-�- JL�L CITY: � ,lE'- ��� ZIP: S 5 3� Y
STATE LICENSE: � �� �' a
_ PHONE:
ARCHITECT/ENGINEER:
MAIZING ADDRESS:
CITYr ZIP:
REGISTR.ATION �
NAME:
Addition Accessor Structure Move
TYPE OF WORR: NeW Renovate� Land Alteration
Demo Remodel/Alteration
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PROPOSED WORR (describe in detail) : �L`'`'r `
STORIES: � S4• �ET OF EACH �+�R= �5���
NO. OF BEDROOMS: " GARAGE STAL.LS: ATT. DET.
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ESTIMATL�D CONSTRIICTZON VALIIATION (ezcluding Iandl : S �7. �
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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 �^'1thathI
ordinances and codes of e�mit1and work ishn t to start without a permit; and
understand this is not a p ,
that the work wil 1 be in accordance with the approved plan.
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APPLICANT'S SIGNATDRE:
- �, ��C DATE. c7
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- :� CI'1'`.�' O� ORO
41 Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
s _ � o 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 f rom 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 Iicense requested.
2. You may refuse to supply data, but refusa3 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
Iicense.
4. If your requested permit or 3icense 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 full name is required to procsss this application or
pe?-mit.
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First
Middle Last
�j y,� S�jti�� � � � � �- -
Address
� �' � z ��v-�— /�'���- S ��
Cit State Zip
� �� _ � s- � �
Phone
I understand my rights as stated above.
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Signatur � . �
BUILD[NG&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING