HomeMy WebLinkAbout1991-003850 - tear off/re-roof PERMIT
�ITY OF ORONO PERMIT TYPE: �;�;��;;��,��;
1335 Brown Rd. South • P.O. Box 66 Permit Number: "`}�="=�'`•'
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Crystal Bay, Minnesota 55323 Date Issued: '
(612) 473-7357
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APPLICANT PERMITEE SIGNATURE SSUED BY:SIGNATURE
� � CITY OF ORONO - BIIIZDING PERMIT APPLICATION -
Total Fee: $ Date Received•
Date Approved: -
Entered By:
Permit#:
ALL INFORMATION IriDST B$ SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
------------
---------------------------------=---------------------------------
THE APPLICANT IS: (circle one) OWNER or ONTRACTO�
Z�S� / ��
a70B $I'1'E ADDRE$$: �E'��,'✓� Iz't/ d�"� � ZIP:
(work)
N�ME OF OWNER: ��� a �r`�u�G��' PHONE: (h ome)
—_� . r
MAILING ADDRESS: 2'�sv �G�>��w�/S,� �' CITY: L1,'��tz, ZIP:
CONTRACTOR: I�� 1�' IL � � ^'t'�'`'�'L�r ( �''�S PHONE: `'�' � - � `�l � �
MAILING ADDRESS: ��I � � �`�� �1 - CITY: L�'(��I� ZIP: � S� � � l
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate )C Land Alteration
r��r�sEn
WORR (describe in detail) : /�-���'��t)�� fX`'s �� " �S `l`�� /�S ' '� -� ~� �
����� l "� ��v!-f'G� '�� �L,<v S � �� /' �!/�.C.0 �-[�S
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BBDROOMS: GARAG$ STALLS: ATT. DET.
�,.c
ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ ?��v f
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
�rdinances and codes of the City and with the State Building Code; that I
�.:nderstand this is not a Fermit and work is not to start without a �ermit; and
that the work will be in accordance with the apFroved plan.
� �
�1rL�,� /� DATE: �J �� �I�
1�PPLICANT'S SIGNATURE: —
(Please fill out the reverse side of this form)
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-:������~ CITY of OROl\TO
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Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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"�� _ � F. �'� ' On the North Shore of Lake Mirznetonka
DATA_ PRIyACY ADVISORY
In accordance with M.S. 15.165, "Rights of subjects of data", we
woul.d like 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 wi13 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 license.
3. The information may be shared with other local , state or
federal agencies to the extent necessary to process the permit or
�icense.
4. If your requested permit or Iicense 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.
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Phone
I understand my rights as stated above.
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Si�nature
BUILIIING&ZONING—473-735 i • ADMINISTRATION&FINANCE—d73-7358 • PUBLIC WORKS —473-7359
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