HomeMy WebLinkAbout1990-003379 - bay window addn PERMIT
CITY OF ORONO PERMIT TYPE: �Ji ;.�i f�t�
1335 Brown Rd. South • P.O. Box 66 Permit Number: ��`� �'�°�'
Cr stal Ba , Minnesota 55323 i� ������� �
Y Y Date Issued: �-� j->;
(612) 473-7357 �'{"s� `�r, '?�j
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CITY OF ORONO - BIIILDING PERMIT APPLICATION
,
Total Fee: $ Date Received:
Date Approved:
Entered .By:
Permit#:
ALL INFORMATION MUST BE SOBMITTED IN FIILL BEFORE PLAN REVIEW WILL BE STARTED
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THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: . �� y� � y ,�j n� � ��� ZIP: �s... `� J �
(work)
NAME OF OWNER: lJ�A N j( �J �- � �� PHONE: (h ome)`f�J3- 7`�S �
MAILING ADDRESS�`�$ C�yc �,�� F' L CITY: L�r�, L��.� ZIP: S5 3 5 G
CONTRACTOR: PHONE:
MAILING ADDRESS: CITY: ZIP:
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration '� Renovate Land Alteration
PROPOSED WORK (describe in detail) :
��'� l�/ 1 N D o�.,� A d � t g g,�J - �,� �J p � „`�
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTROCTION VALDATION (excluding land) : $
I hereby apply for a building permit and I acknowledge that the informatic
above is complete and accurate; that the work will be in conformance with t�
ordinances and codes of the City and with the State Building Code; that
understand this is not a �ermit and work is not to start without a permit; an
that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATIJRE: ,�� _. ���1� DATE:�Q �u,C�f 1 6
(Please ill out the reverse side of this form)
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'�,,'F` ' ���'�'� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Office
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;',,�"�' � y On the North Shore of Lake Minnetonka
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DATA__PRIVACY ADVISORY
In accordance with M.S. 15.165, "Rights of subjects of data", we
would like 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 will 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 shared with other local , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself .
6. Your full name, and date of birth are required to process
this application or permit.
,p�� N K��;T�,� �I� L `._�— - - -- � s� ��c-- 3�
First Middle Last
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Address
F-ni��!1.t' _"_ �'��.�c�-�-�—_._ '•__' ___.'"'___!�"�v_" ._.._ . .-'____'__._.��--�_J �".__ ._."_'_.."
City State Zip
_ .
`173 _ /`� s--G- ---�- ----- ------ .._
Phone
I understand my rights as stated above.
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Signature
BUILDING&ZONING—473-7357 • ADML*IISTRATIOfY&FINANCE—473-7358 • PUBL[C WORKS—473-7359
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