HomeMy WebLinkAbout1994-006369 - revised plan new residence ' PERMIT
I CITY OF ORONO � PERMIT TYPE: � _, .- , , ; .. _
2750 Kelley Parkway • P.O. Box 815 " ^ "`-`-�'` '�`-'
Orono, Minnesota 55356-0815 Permit Number. �';�'.i��:�;:�:���
' (612) 473-7357 Date Issued: - -- •�'-��.���'�4=
SITE ADDRESS:
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, PPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO - BIIILDING PERMIT APPLIC�TION
� � � ' Date Received:
� Total Fee: � -
� Date A�proved: '
� Entered Bv: Permit�: - __
; ' �
�
AT�T• INgOEt�"iATION MIIST Bg SIIBMITTED IN FtnL BEFORE PI�AN RE�7IEW WII� BE SgBRTE�
' (See Check-aff List Enclosed) ___________
�� �PL=�pT Zg: (circle one) Oj�7`TER or CONT.�ACTOR
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JOB SITE ADDRSSS: .,� .
(work) � �
� � �
�' ��t � HONE: (home)
N� OF OWNEFZz �
� CITY: ZIP:
MATI,ING ADDRESS- µy
PHONE:
CONTRACTOR: �
�Z.�,: ZIP:
MATT,ING ADDRESS:
STATE L2CENSE: �
�' ? /"1 � ��/
• � �„ PHONE: � / � — �
ARCHITECT�ENGINEF�: � � � � .--
� � ' �`''�CITY: �� �' ZIP-
M.AILI27G A.DDRESS:
R.EGIS�RATION =
NAME:
� Additian Accessory Structure Move
�pE pg 4.;pgg: New Renovate Land Alteration
De�o Re.*nodel/Alteration
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PROPOS�D WORR (describe in detail) :
� � ��/'� ✓ ,.�
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`� SQ. FEET OF EACS FLOORs
STORSES:�
NO_ OF BEDROOMS:
G�,�RAGg STALI,S: ATT. DET.
ESTIMATE� CDNSTRIICTION VALIIATION (e�c�udinq
Iand 1 : $ ` --
I hereby apply for a building permit and I ac?cnowledge that the information
lete and accurate; that the work will be in conforntaCn de W �h �he
above is comP and with the State Building e�it; and
ordinances and codes of the City
understand this is not a permit and work is not to start without a p
that the work will be in accordance with the aoproved pZa-n- _ .
� �� �_��' � ✓'' DATE- �
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� . . Minaesota 5�323•Municipal Offices
j �� Post Office Box 6& Cr5'S� Bay�
� • -
On the North Shore of Lake Minnetonka
;� � ` • �
p DATA PRSVACY ��SORY
� Subd. 2 , "Rights of subjects of
� Tn accordance with M.S. 13.04 ► our request for a permit or
we would like to inform you thof its departments may require
data" , oi prono or any
� license from the City rivate or confidential information.
h you to furnish certain p
� You are notified that:
�ap �, The inrormation you furnish wil.l be used to determine your
9 �ual ; i=cation for the pe�-lnit or license requested.
� u;re tnat
� refuse to supply data, but refusal may req
� 2. You may
den tne pe�i� or license.
a the City Y � �-o or
v be snared with otner local , s�a�.-
3 . The information mal to process the permit or
federal agencies to the extent necessary
�icense. . •
or iicense requy�Ps Counc�i ac��o%
a, If your recuested Pe�z� uD1ic.
; ma become p
to aporove, some insormat_on Y
J•
You have certain rights under M.S. 13.Oa to review pr'-va�e
� data on yourself. .
k � ,
� roc�ss �===5 aDD ��ca�_on or
r
c E , Your full name is require �o P
a
per-.nit.
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�. I understand mY rights as stated above.
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� � PUBLIC WORKS -473-7359
' • pDMINISTRAT70N&FINANCE-473-7358
� BUILD[NG&ZONING-473-i 35�
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