HomeMy WebLinkAbout1992-004530 - re-roof/overlay � _ PERMIT
����� �F' ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 �;k}�����,���
Permit Number. t�t��.�::i�
Crystal Bay, Minnesota 55323 Date Issued: i 7�
(612) 473-7357 � �`��{-��`
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: — AF�F=I icaz-�t. — OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE ��(�c/
� CITY OF ORONO - BUILDILIG PER�tiiIT APPLIC�TION
Total Fee: $
t�/' � E, Date Received: ��=�� � y �
Date Agpro�ed :
Entered By: �_-�.' u. �-
- Permit,�. ��_�-���
ALL INFORMATION MIIST BE SIIBMITTED IN FIILI� BEFOR.E P7�AN REVIEW WILL BS STARTED
(See Check-off List Enclosed)
-------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOBr'
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JOB SITE ADDRSSS: ,' '=� � �` ���` ' �%'r�� /�! ZIP: �S�j�
(work)
' ^ ; PHONE: (home) • '/�f
NAME OF OWNER: ` >� �-, ,/�', �`j �,� % ,"'�,.
=� ���' .` �C, CITY: �%/1:��! ZIP: _: .=_�;';/
MAIZING ADDRESS:-�_�J� � t��/.����C �e«� � ,•
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CONTRl�CTOR:� '°�i��:�!��.� -���-�%lz'�J/_c�--f (_ �' PHONE:�,�G� ����%� -
MAILING ADDRESS:� .�' �"' ' CITY:/,�f,,�'t ,�H'�%�-' c ZIP - _�!�
t��"-�� % �/�r<':l% f' �—.T
STATE LICENSE: � �----
ARCHITECT/ENGINEER: PH��'
MAII.ING ADDRESS: CITY: ZIP:
pA�: REGISTRATION �
TYPE OF WORK: New Addition Accessory Structure Niove
Demo Remodel./Alteration Renovate Land Alteration
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7 }_,�-� . /,, '3 i
PROPOSED WORR (describe in detail) : /� "/c l�� /�"'�'�� � �'����
STORIES: SQ. FEST OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STAZ.I.S: ATT. DET.
✓ .
/ z ;.. .
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ " „���C '�-�• J
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 is not to start without a permit; and
that the work wi.11 be in accordance with the approved plan. �
_ �'�;� � �' �--
APPLICANT'S SIGNATURE: '. �- ' •� ' DATE: J' - =i'% - /.
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:-.y � ' Post Office Box 66•Crystal Bay, Minnesota 5�323•Municipal Offices
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�`�, On the North Share of Lake Minnetonka
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DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of
data", we would like to inform you that your request for a permit or
Iicense from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish wil.l be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to suppl.y data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be snared with other local , 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�ior.
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 process this application or
permit.
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First ` Midd e
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Address
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Cit� State Z1p
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Phone
I understand my rights as stated above.
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ignature `� �
E3UII.DING& ZONING —473•73�7 • ADb1INISTRATIOv&FI�1�NCE— 473-7358 • PUBLiC 1yORi�S —473-7359
ASSESSI�IG