HomeMy WebLinkAbout1993-005262 - remove dead tree PE�I��IT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 ���'��` �-��� '��"�"
Orono, Minnesota 55356-0815
Permit Number: i�,i�.�•wi=,;�
(612) 473-7357 Date Issued: :��:,,=1 :;!�a::;
SITE ADDRESS:
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———— — :+PPLICANT-PERMITEE SIGP ATURE ISSUED BY:SIGNATURE �
.+� .
' CITY OF ORONO - BUILDING PER�i1T APPLICATION
Total Fee: $ -� Z ' l (' � V v v Date Received:
�U N �i 0 "i993
Date Approved:
Entered By:_����' � �, �
Fermittt: ��
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AT•T. INFORMATION MIIST BS SIIBMIT�ED IN FIILL��-��ORE PLAN REVIEW WILI. BE STAR
(See Check-cff I.ist Enclosed)
--------------------
THE APPI,ICANT IS: ( circle one ) C<<I�IER or CONTRACTOR
JOB S
ITE ADDR$SS: ��� � i/ � �"f��ZIP: ��� I
(work) ���� �7 ��
�� f �/�� � PHONE: (home) � -� ! �
NAME aF OWI3ER:�►M l d✓ � �"l � �' —
c�' S�a.� � �'V n, ,� �1P: �.3 3�
? �
MATZ�ING ADDRESS: ,I���� 1TY: *X /�
CONTRACTOR: PH���
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: �
ARCHITECT/ENGINEER: PH��"
MAIZING ADDR.ESS: CITY: ZIP:
N�: R.EGISTRATION n
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration�
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POSED WORR (describe in detail) : ��� � ��`�`�''� �f Lf� _
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALI�S: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl : $
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the work will b� 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 zo start without a permit; and
that the work will be in accordance with the app roved plan. �
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APPI,ICANT'S SIGNATURE. �'
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; r��'�: Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
9 ;k;:"�
• - • ��' On the Nortlz Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of
data", we would Iike 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 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 license.
3. The information may be snared with other Iocal , s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Zicense 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 proc�ss this application or
permit.
�� ���� ����t
First Middle Last
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Address
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City State Zip
�'�� -� ��f��
Phone
I understand m r' g t as stated above.
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Signature
BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359
ASSESSIN G