HomeMy WebLinkAbout1994-005873 - kitchen remodel �' PEI�MIT
� ~CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: -��.�� !_E;'����!`-�
Orono, Minnesota 55356-0815 °_���_;�=����.�='
(612) 473-7357 Date Issued: _ .
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APPLICANT�PERMITEE SIGNATURE ��� ISSUED BY:SIGNATURE �
� ' CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:�r"�'� Permittt: ���-3
AT.T• INFORMATION MIIST BB SIIBMITTED IN FIILI� BEFORE PLAN RE�7IL'�n1 �"TIL2� BE STARTED
(See Check-off List Enclosed)
TgE APPLICANT IS: (circle one) O�VNER or CONTRACT
JOB SITE ADDRBSS:
� - ' ZIP:
(work)
,SC �//f//� PHONE: (home) / / - ����
NAME OF OWNER: �4' /'�
ry � �� ,/'7� ITY:///'�/1O ZIP:
MAILING ADDRESS: �d�����7
CONTR.ACTOR:__���/' /�i,l/'��,������r�/I�Pl�7� PHONE: OU�Y"��U��
MAILING ADDRESS: /Z � `l CITY: �j'!�//%P-/d/ Z IP: ��' y� i
STATE LICENSE: # / ��
ARCHITECT/ENGINEER: PHONE:
MAIZING ADDRESS: CITY: ZIPs
N�_ REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration� Renovate Land Alteration
PROPOSED WORR (describe in detail) :
STORIES: SQ. FEET OF EACH FZOORs
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ / / ���
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 i not to start without a permit; and
that the work will be in accordance wit r ed plan.
, DATE: � �� —
APPLICANT'S SIGNATQRE:
,
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���.�-��"��+r:
���� �r�. �� �I�Y o� �RONO
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�. --��;;; 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 3.ike 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 confidentia3. information.
You are notified that:
1. The information you furnish wil.l 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 Iicense.
3. The information may be snared with other Iocal , 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��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 proc�ss this application or
permit.
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First Middle Last
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Add ss
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City State Zip
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Phone
I understand my rights a stated above.
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BUILD[NG&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSIN G