HomeMy WebLinkAbout1993-005375 - tearoff/reroof/porch ,
, : PEI�MIT ���
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: �"''' f:T'a��
Orono, Minnesota 55356-0815 "'-'�=`�`
(612) 473-7357 Date Issued: 4;;::�_�:,t.:�::;
SITE ADDRESS:
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APPUCANT/ RMITEE SIGNATURE ISSUED BY:SIGNATURE �Q,�*�,G,,(
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CITY OF ORONO - BUILDING PER�IT APPLICATION
Total Fee: $ /S -��' Date Received:
Date Approved:
Entered By: �'"_:�
Permit�: 'S�'7``�
AT•T, INFORMATION MIIST B$ SIIBMITTED IN FIILI� BEFORE PLAN RE�7IEW WILI+ BE STARTED
(See Check-off List Enclosed)
---------------------------------------------
TgE APPI,ICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRBSS:��`l C�SG F) �� /?Q ZIP:
(work)
N�ME OF OWNER: �r� CJG�l�1. / ��� PHONE: (horae)
MAIZING ADDR.ESS: Z D 1I C�SCo �7 /� CITY- /��¢!/a9�?/�C ZIP:
CONTRACTOR: � pHONE: � 7 Z�� S Dv
MAII,ING ADDRESS: 3/(� L�'!t>eKh�� � CITY: /�OCJ�I� ZIP: :`���36�
STATE LICENSE: #
ARCHITECT/ENGINEER: PH��'
MAILING ADDRESS: CITY: ZIP:
N�: REGISTRATION tt
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PRO OSED WORR (describe in detail) : ��!-��L` �+� � � ��� ��Or�'C
0�C�
STORIES: SQ. FEET OF EACH FI.00R=
NO. OF BEDROOMS: GARAGE STAI�LS: ATT. DET.
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ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ 5���
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 w rk is not to start without a permit; and
that the work wi1.1 be in c rdan w th the approved plan. �
APPI,ICANT'S SIGNATORE:
DATE: < -z S � J��
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~��^S6 Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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• - e •� � 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 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 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 snared with other Ioca1 , s�ate or
federal. agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Council 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
� pe�-mit.
First Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature
BUILDItiG&ZOY[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING