HomeMy WebLinkAbout1990-003228 - tear off/re-roof PERMIT
CITY OF ORONO PERMIT TYPE: �:t�I�C:zI���
1335 Brown Rd. South • P.O. Box 66 Permit Number: ";t��'=��i`='
Crystal Bay, Minnesota 55323 Date Issued: ":'��f i'���='�k
(612) 473-7357
SITE ADDRESS:
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APP�ICANT�PERMITEE SI ATURE ISSUED BY:SIGNATURE
' CITY OF ORONO - BIIILDING PERMIT APPLICATION
! � ��:. c j,``; .
� Total Fee: $ ' � Date Received•
� Date Approved:
� Entered By: --� __ a
, Permit#: -�,..,��_' �
�
� ^
�
� ALL INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL BE STARTED
� -----------------------------------------------------------------------------�
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: I� � CI�-C�VY CI�SG� ZIP:
(work)
NAME OF OWNER: ��C ��-l��/Ll(-��'S/��'� PHONE: (home) � � 96/-�
MAILING ADDRESS: � 2? Cr�/�vr ChY►-�"e CITy; �/Lr�!"� ZIP:
CONTRACTOR: � � Sn'���N ��• ' PHONE: Y�a - G���
MAILING ADDRESS: S�75' GY���i���YJ� CITY: ���✓NL� . Iy���� ZIP: �S.3�Z-
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovat� Land Alteration
�oar�r� 6
PROPOSED WORR (describe in detail) : �G�-� ��' �NL� C/��t�2 �!'�` __
S t'�% ►-��Lcs �+n� s'I`/9 G G l�-2.,"' v✓
�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
-7�v o a
ESTIMATED CONSTRIICTION VALIIATION (exclnding land) : $ c7� /
I hereby apply for a building permit and I acknowledge that the informat�,
above is complete and accurate; that the work will be in conformance with Y
ordinances and codes of the City and with the State Building Code; tha-
understand this is not a permit and work is not to start without a permit;
that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATQRE: `/ ' ^ DATS: �����
_- _ - .
_ .
;:� - _ (Please fill out the reverse side of this form) _ �
� '�
���rY �� o�oNo
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
o.
o _ � A On the North Shore of Lake Minnetonka
DATA_PRIVACY ADVISORY
In accordance with M.S. 15.165, "Rights of subjects of data", we
would Iike 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 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 shared with other local , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permit.
W 1�►'Ll1�o" � �I�� /%/ ------ --- - --- -
First Middle Last
S-9 7S Lv �_� � L v�---- -- - _.------ _ _ .. . ._ .._
-- - _. _ _ __ . _ _�._�r�-.._ _.�- - - --- -.----- ___.
Address
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._. __ .. ---- _
City State Zlp
y �� ^6��y .
_ _ .- _ -- �--
Phone �
I understand my rights as stated above.
'� - - --- ---------- •
Signature
- BUILDiNG�ZONING—473•7357 • ADMINISTRATION&FINANCE—473-7358 . . � PUBLIC WORKS—473-7359 �`_�
A3SESSING _