HomeMy WebLinkAbout1992-004571 - land alteration P�R�i�IIT
CITY OF ORONO PERMIT TYPE: ��:_,�� �F�-jt,��C�
1335 Brown Rd. South • P.O. Box 66 Permit Number: 4��y��7�—
Crystal Bay, Minnesota 55323 Date Issued: i}Y;��;_::r V��,
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - qF��r� i���,t. -
�'�i�1±l=_,�::.�} NARi�LG
�'t7 C:y�=P�IET F'L
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4!TFE GNATURE ISSUED BY:SIGNATURE
CITY OF ORC:70 - BUILDI:7G F��=-�Ii t�.pPLIGaTION
'ota? Fee: $ �U
fr�/ Date Received: ��'/O ' ��
Da�e A��rovec :
-z�.�,-Aa �v: �-'-� '�/
Fe�.-mit�- � �
;_I,y INgOg.MATION MIIST BE SIIBMITTED IN FUI,I� BE.FORE PI�N RE�7IEW WII�L B$ STARTED
(See Check-ar= List �nclosed)
----------------
----------------- -
-gE p,ppl,IC.�NT IS: (circle one ) G�v"�IER or CGNTRACmOR
ZIP:
qB SITE ADDR.SSS s
(work)
PHONE: (hcme)
'?,I�? OF OWNER:
•�ILING ADDR.ESS:
CIZ•y: Z IP:
PH�NE:
'�N�tACTOR:
C=�: ZIP:
�II�SNG ADDRESS:
:TATE LICT'NSE: _
PHONE:
'�CHITECT/ENGINEER:
_;II.ING ADDRESS:
CITY: ZIP:
REGIST?�TION �
.�iE:
YPE OF WORR: i7ew Addition Accessory Structure �iove
De:no Re*nodel/Alteration Renovate Larid Alteration
?OPOSED WORR (describe in detail) :
;TORIESs SQ. FEET OF EAC$ FLOOR=
;O_ OF BEDROOMS: GARAGE ST�S: ATm, DET.
,�Ty�,�ED CONSTRQCTION VALIIATION (egcluding Iand) : $
" hereby apply for a building permit and I ac?cncwledge that tne in�or�ation
�ove is complete and accurate; that the work wi? ? be in conforznance with the
rdinances and codes of the Citv and witn the State Building Code; `�at T
Zderstand this is not a per�it and work is not tc start without a per�it; and
aat the work wi1 I be in accordance with tne approved plan. �
- DATE:
�_PPLICAP7T'S SIG:IATURE: '
' •
: �� � _
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� Post Office Box 60•Crystal Bay, Minnesota 5�323•Municipal Offices
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s ' a g� On the North Shore of Lake Minnetanka
DATA PRI�TACY 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
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:
l. The information you furnish wil.l be used to determine your
cualification for the Der.nit or Iicense recuested.
2. You may refuse to supp?y data, but r�rusal may require that
tne Citv deny the pe�it or iicense.
� . The inrormation may be snared with otze� iocal , s���e or
federa� agencies to the extent r.ecessary to proc�ss tne pe*-:nit or
iicense.
a. If your requested pe�.it or Iicense ;ecuires Councii ac��o%
to a�prove, some inzor.nation may become pub�.ic.
� . You have certain rignts under M.S. ?3.0� to review private
data on yourself.
6. Your fu.I1 name is required to process this application or
per:nit.
First Middle Las�
Address
City State Zip
Phone
I understand my rights as stated above.
Signature
�1LDING 3c ZOVIVG — 473-7357 • ,�DtitivISTRATION& FINAVCE — 473-73�3 � PUBLIC WQRKS —�273-73�9
ASSESSIY G