HomeMy WebLinkAbout1994-006125 - land alteration _
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CITY OF ORONO PERMIT TYPE: ;�,_;�.�, �}�_�.__���r�
2750 Kelley Parkway • P.O. Box 815 Permit Number:
Orono, Minnesota 55356-0815 `-"''=���'
(612) 473-7357 Date Issued: _ ^ _ ;_�;�
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICAN E ITE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO - BIIILDING PER�IIT APPLICATION
Date Received:
Total Fee: $
Date A�Droved: '
Entered Bv: Permit� _ -
AT.T• INgORMATION MIIST BS SUBMITTED IN FIILL BEFORE PLAN RES7IEW WII,L BE SgB.RTF.D
(See Check-off List Enclosed) _______r__________
------
--------- -------c-rcle ane� OtrTNER o�� ONT.QACTOR
i.� APPLICANT IS: � =�
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JOB SITE ADDRSSS: �
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�-"`� �; �� J PHONE: (home)
WNER: il � "` ��--tz;y j ��/
NAME OF O � �� � � '' ,
v CITY: ZIP:
MATL=NG ADDRESS:
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NTRACTOR. ,i� i�F:,���� �L � - _.'T _ �-
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MATLING ADDRESS: � �
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STATE LICSNSE: �
PHONE=
ARCHZTECT/ENGINEER:
CITY- ZIP:
MAILING ADDRESS:
REGSSTRATION z
NAME:
Accessory Structure ` Mvve� :
TyPE OF WORR: New Addition Land Alteration
Demo R�*nodel/Alteration Renovate
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PROPOSED WORR (describe in d,etail) '
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STORSES: SQ. FE,ST OF EBCH FLOOR:
NO_ OF BEDROOMS: G�RAGE ST�S: ATT. DET.
ESTSMATED CONSTRIICTION VALIIATION (�ciu�q I�d) : $
I hereby apply for a buil.ding p
ermit and I acknowledge that the information
above is complete and accurate; that the work will be in conform C de;'�ith t e
ordinances an d co des o f t he C i t y and with the State Building e�it; and
understand this is not a permit and work is not to start withou t a p
• • ce with the aporoved pl�n-
� _ . _ _.
that the work wa.I.l be in accor an / .
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,;j �.. � ��.�`°-�=� , DAZ'E: -)�_ / 1
APPI.SCANT'S SIGNATURE: ���
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�� Post Office Box 66•Crystal Bay, Minaesota 5a323•Municipal Offices
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On the North Shore of Lake Minnetonka _
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
we would like to inform you that your request for a permit or
data", of its departments may require
license from the City oi Orono or any
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish wil.l be used to determine your
qualification for the permit or license requested.
2, You may refuse to supply data, but resusal may require that
the City deny the permit or license.
3. The informat�o the ext entnnecessaryhto processcthe permit or
federaZ agencies
license.
a. If your requested permit or Iicense requ�res Councii ac��or_
to aporove, 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 proc�ss this application or
pe�it.
First
Middle Last
Address
City
State Zip
Phone
I understand my rights as stated above.
Signature �
BUILDING&ZONING—473-7357 • ADMINISTRAT'ION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSING