HomeMy WebLinkAbout1992-004404 - tear off/re-roof garage ! � ��ERMIT
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1335 Brown Rd South • P.O. Box 66 Permit Number: �t i��t�q.�G
Crystal Bay, Minnesota 55323 Date Issued: i��r�=.i 11�j�
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: – AF�plic�nt� –
PA I C;E Ri iE�E�T
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APPLICANT Pf� MI1 L E SIGNATURE ISSUED BY�SIGNATURE
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CITY OF ORONO - BUILDING PER�'LiIT APpLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: �r`�� C `�
Fermit�:
ALI� INFORMATION MIIST BE SIIBMITTED IN FIILI� BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
--------------------------------------------------------- -
THE P.PPLICANT IS: (circle ane) O��TNER or CONTRACTOR
JOB SITE ADDRBSS: 3yQ3 �r�sr�L �z1�'� ZIP: c��J / �
(work) � -���/
NAME OF OWNER:�OQC� �1 ' �,t��C PHONE: (home) ���'7c�f /
MAILING �Dx�ss:3�f3 �'2l�ST/�L ��I�E" cl�: �I� 2�T� zzP: ��3y�
CONTRACTOR: PH��'
MAILING ADDR.ESS: CITY: ZIP:
STATE LICENSE: �
ARCHITECT/ENGINEER: PH��'
MAILING ADDR.ESS: CITY: ZIP:
p�E: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure blove
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : �U T �� N C� ��d�
�t�'�Cx �C� T - S��/,���r'�"�s -
STORIES: ( SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
,/ O b�
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ '7�
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 wil 1 be in accordance with the approved plan. �
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APPLICANT'S SIGNATURE: � DATE: /d �
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��TI' o� O�►OI\T�
� • Post Office Box 66•Crystal Bay, Minnesota 5�323•Municipal Offices
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' ,� _ a �� On the North 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
Zicense 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 Wiii 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 snared with other Iocal , s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your reauested permit or Iicense requires Council 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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o,��T J 1�m��s �► ��.
First Middle Last
34 t3 �n� s �r�� �� � ��
Address
L�/�t Z� T"� /?� ��31`��
City State Zlp
�71-��2 �
Phone
I understand m rights as stated above.
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Signat re
BUILDiNG& ZONING—473-7357 • ADbfIN1STRATION&FINAtiCE —473-73�8 • PUBLIC WORKS —473-7359
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