HomeMy WebLinkAbout1992-004332 - reroof/tear off - , —
�'ERMI�
, � � OF ORONO PERMIT TYPE: i�
'.rown Rd. South • P.O. Box 66 Permit Number: ��i�.�;�Z��`��
Crystal Bay, Minnesota 55323 Date Issued: ��_,�"''� :-, i>5j 15f_=�:�
(612) 473-7357 ��� �
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DESCRIPTION:
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CONTRACTOR: OWNER: — A�F�1 i c ant. —
Fj iRE'=:TEF� HE�i',EL
=�'a'� C:�Y'��TAL F'L
i�(��;�i�i� P'lh1 ��:1��1
� �71-7F,��.
_ _.._ _ ____ _-- -__.- __-- _--- __ ______ _--__-- ---�
THE ���lGE�t:��I�:�NED HF��:�Y REs:�t��_�'.� F'E�it1 I �_ I��r1 Ti i I�1t�k::E THE REA� I t'!�'�t��VEM��lT_�
=;F'E��I F I�:C� �h�[t? AGf�EE'�; Tt::f Gf�� �;t L W���R��:: I N ;":Th I C.-�" �:i��h�PL�ANC:E W I TN �1LL C:I�Y E:iF
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE �.�
� CITY OF OROl+IO - BUILDING PERMIT APPLIGATION
• Total Fee: $ /�j `��% _ Date Received:
Date Approved :
Entered By: ,('/��'
' Permit#: `�3���-
AT•T• INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WII,Z BS STARTED
(See Check-off List Enclosed)
----------------------------------- , ---------------------------------------
THE APPLICANT IS: (circle one) �OWNER r CONTRACTOR
JOB SITE ADDRESS: ,�Jrl y ��v-S�/�C �� ZIP: v� ��y�
(work) 3�(l � 73/�>
NAME OF OWNER: ���/�5�� /� �i''%S r�/C PHONE: (home) �7/ ��-��
MAILING ADDRESS: ��5�� (�P.�ST.�L �C CITY:�Z�%a ZIP: S -�� 39/
CONTRACTt1R: PHONE:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: �'H��=
MAILING ADDRESS: CITY: ZIP:
N�yg: REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
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PROPOSED WORR (describe in detail) : ��� �' �ft� ��
<�/r� ��i" aCi' ���; �r�i .�/�%�/ �/���cc rc 5
STORIES: I SQ. FEBT OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. �-
�C�
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ � ,-
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 will be in ac,Eordance with the approved plan. �
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T' SIGNATDRE: y' ���� /� � � DATE: ,S-/.�- ��
APrLICAN S l
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=�����- � CITY of ORONO
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1� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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� _ s � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of
data", we would I.ike 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.I be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusa3 may require that
the City deny the permit or Iicense.
3. The information may be shared with other local , s�.ate or
federal agencies to the extent necessary to process the permit or
I.icense.
4. If your requested permit or license 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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First Middle Last
�3S/`��/ <'�,�5 T� i�� -
Address
��/,� Z T� ���,� .��.��/
City State Zip
� / �� � �/ 7� .�/
Phone
I und�rstand my rights as stated above.
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Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FIN��vCE— 473-7358 • PUBLIC WORKS —473-7359
ASSESSING