HomeMy WebLinkAbout1989-002375 - repair garage ;: i
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35 Brown Rd. South • P.O. Box 66 Permit Number:
��stal Bay, Minnesota 55323 Date Issued: ���.... ...::. :.......
(612) 473-7357 ` `•.:` `'`-„ '-`-
SITE ADDRESS: '
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PPLICANT PERMITE AT F ISSUED BY SIGNATURE
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� Y �F' V�{� � PERMIT TYPE: E;;_�;i ,:�`��;_1
'5 Brown Rd. South • P.O. Box 66 Permit Number: _{�_t:°�:7=�
stal Bay, Minnesota 55323 Date Issued: :.-:_:f��_:=;!����`_=?
2) 473-7357
~� APPLICANT:
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- ��YPE: TYPE OF WORK:
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�d�t� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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.�� _�A� ,r' On the North Shore of Lake Minnetonka
DATA__PRIVACY ADVISORY
In accordance with M.S. 15.165, "Rights of subjects of data", we
wouZd 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 will be used to determine your
qualification for the pe?-mit or license requested.
2. You may refuse to supply data, but refusa� may require that
the City deny the permit or Iicense.
3, mhe information may be shared with other Ioca1 , state or
f ederal agencies to the extent necessary to process the per.nit or
�icense.
�. If your requested pe�mit or Iicense reauires Counci i action
to approve, some information may become public.
5. You have certain rights under M.S. 15.16� to review private
data on yourself .
6, Your fuyl name, and date of birth are required to process
this application or permit.
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First Ie Last
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Cit State Zip
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Phone
I understand my rights as stated abo�.
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Signature
BUILDING&ZONING-473-7357 • ADMIIVISTRATION&FINANCE-473-7358 � PUBLIC WORKS -473-7359
.aSSESSING
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CITY OF ORONO — BIII7sDING PEF21�iIT APPLIC�TION
Date Received: .
Total Fee: $
3 '� Date Approved: .
o �3� s
Entered By: pe�-mit�.
�Ly ZNgORM�1TION MIIST Bg SIIBMIT'�ED IN FLTLI' BSFORE PLAN REVIEW WIIS. B$ STARTEP
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�� �pI,I�� IS: (circle one) OWNER or CONTRACTOR
---- - ZIP:
JOB SITE ADDRESS-� (_ - _ ` J ( � � � U �--' J�,S 3 �� .
� ° � � �� � (work)
���- PHONE: (home ) �� �/�
2dAME OF O��: C�
- 6� � �C� 6� :�-- cz�: zP: �J 23�
MATLING ADDRESS.
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-- p3�NE:
CONTRACTOR:
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�------ C?TY:
MAIZ�ING ADDRFSS:
�� • Accessory Struc�u�e Mcve
TYPE OF �TORR: New Adc_:.�on
Demo Remodel/Alteration
Re^�ovate Land A1�eration
C � �. -c2���-
PROPQSED i�ORS (describe in detail) :
STORSES= SQ. FEET OF EACH FI�dOR:
NO. OF B�DROOMS: GA�GS STAI�LS: Amm, DET.
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_TED CORSTRIICTION V�iI.IIATIOF� (e�clnding Iand) : $ / C�
ESTI�''jP
I hereby azply for a building permit and I acknowledge that the informa'.
above is complete and accurate; that the work will be in conformance with
ordinances and codes of the City and with the State Building Code; thG
understand this is not a Fermit and work is not to start without a permit;
that the worx will be in accordance with tne approved plan.
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APPLICAEZT S SIG�IATIAZE- -
(Please ?=ill out th e erse side of this �o�:,►)
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