HomeMy WebLinkAbout1993-005196 - re-side - � P I�MIT
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2750 Kelley Parkway • P.O. Box 815 �'�`��-�"�����`
Orono, Minnesota 55356-0815 Permit Number: i;�_;c 1=_;�,
(612) 473-7357 Date Issued: ;;;�,;�;; ::��;:^:
SITE ADDRESS:
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REMARKS:
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FEE SUMMARY:
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APPUCANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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• CZTY OF ORONO - BIIILDING PERMIT APPLIG�TION
Date Received:
Total Fee: $
Date Approved :
Entered By: permit�:
AT.T, INFORMATION MIIST BR SIIBMITTED IN FIILL BEFORESeI�N REVIEW �Z'I' BE STARTED
{See Check of� List ________________
---------------
TgE AppI,ICANT IS: ( circle one) 0��7NER or CONTRACTOR - ���
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JOB SITE ADDRSSS s I �C�� �►m�}�O � -
(work)
� N PHONE: (home) ��a^o (�.
N� OF OWNERs
�'"I�O �, CITY: ZIP:
MATLING ADDRESS: U
PHONE:
CONTRACTOR:
CITY: ZIP:
MAII�ING ADDRESS:
STATE LICLNSE: �
PHONE:
ARCHITECT/ENGINEER:
CITY: ZIP:
MASLING ADDRESS:
REGISTR.ATZON z
NAME:
Accessory Structure Move
TYPE OF WORR: New Addition Land Alteration
Remodel/Alteration Renovate�_
Demo �� ` '
PROPOSED W�RK �describe in detail) = '
t SQ. FEET OF EACH FLdOR: ���
STORIES: '
NO_ OF BEDROOMS s G�GE STAI�I�S: ATT. DET.�
(� �� �l
ESTIMATED CONSTRIICTZON VALIIATION (excludi.ng lanal = $ "'��
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 wi��ha�hE
vrdinances and codes of the City and with the State Building Coermit; anc
understand this is not a permit and work is not to start without a p
that the work will be in accordance with the approved plan.
DATEs � �
• APPLICANT'S SIGNATIIRE:
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!1 ��--��;: Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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�. _ � ov2� On the North Shore of Lake Minnetonka
DATA PRNAC�' AD�TI S ORY
�In accordance with M.S. 13.04 , Subd. 2 , "Rights of subermit or
data", we would like to inform you tha,t your request for a p
license from the City of Orono or any of its departments may require
y,ou to furnish certain private or confidential information.
You are notified that: •
1. � The information Y°ermit or licensebrequet ed, determine your
Qualification for the p
2. You may refuse to suppl.y data, but refusal may require that
the City deny the perntit 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 Iicense requires Councii ac��or_
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
5 . Your full name is required �o proc�ss this application or
pe?.nit. ,
�
First Middle Last
��
Address •
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1�1�„� �'�3 � � '
City State GlU
� �-{�.a.-��o s�
Phone
I understand my rights as stated above.
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BUILDING& ZONING—473-7357
� ADMINISTRATION&FINANCE- -173-7358 • PUBLIC WORKS —473-7359
ASSESSING