HomeMy WebLinkAbout1991-003601 - re-roof PERMIT
t � ' �F ORONO PERMIT TYPE:
�:n Rd. South • P.O. Box 66 Permit Number: �iiil,�;i�;�,���'
Crystal Bay, Minnesota 55323 Date Issued: ;,;_;;��,;i�
(612) 473-7357
SITE ADDRESS:
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PLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE ��—
CITY OF ORONO - BDILDING PERMIT APPLICATION
i ' �
Total Fee: $ Date Received;
j Date Approved:
; Entered .By:
Permit#: --� ��' /
;
;
ALL INFORMATION 1KDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL BE STARTED
THE APPLICANT IS: (circle one) OWNER o CONTRACTOR �
JOB SITE ADDRESS: �
-S ya � ,L � C�G�e � Z I P:
(work)
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NAME OF OWNER: -r-i,� is ,n_ ��c-�e v PHONE: (h ome) ����-5��7
c , o.i z�t r/ � CITY: ��r.,c ��,�e ZIP: i�S S'��
MAILING ADDRESS: /L O/ � L� � / �{
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CONTRACTOR: 'o S.,o � � o�, ,�-- � ,L�c �� �ors � PHONE: y7/ - j/��/
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MAILING ADDRESS: s�� ��-_� a .� i,, Sz CITY: /�c-�v��� ZIP: �S� y
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : .� � � c�o
STORIES:�_ SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALDATION (excluding land) : $ �/�� �
I hereby apply for a building permit and I acknowledge that the informatio
above is complete and accurate; that the work will be in conformance with tr
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 �ermit; an
that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATQRE: --4�j - r'=
DATE: 3 -� /
(Pleas fill out the reverse side of this form)
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4 �
e � IY'��� c�F.�� .�'V .
:9]��£ ,3, � �.��!P6
�Y���;t����t���, C ITY of ORONO
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�� '� "''ry''` Post Office Box 66•Crystal Ba Minnesota 55323•Munici al Offices
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i�. ..:��'*e,, On the North Shore of Lake Minnetonka
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 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:
1. The information you furnish wili 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 Iicense.
3. The information may be shared with other Iocal , state or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or license 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.
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Address
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City State Zip
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Phone �
I understand my rights as stated above.
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ignature
BU[LD(NG&ZONING—473-7357 • ADMLTVISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING