HomeMy WebLinkAbout1993-005400 - tearoff/reroof - PEI�MIT . �
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: �����!=�����
Orono, Minnesota 55356-0815 �_��s����!_���_�
(612) 473-7357 Date Issued: i_.;; <<:f .,�_;
SITE ADDRESS:
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� APPLICANT/PERMITEE S ATURE � ISSUED BY:SIGNATURE '�{� .
CITY OF ORONO - BIIII�DING PERMIT APPLIC.ATION
Total Fee: $ � `% � � Date Received:
Date Approved:
Entered By: �� pe��t n:�`� y :�) _
AT•T• INgpRMATION MIIST BS SIIBMITTED IN FIILZ BEFORE PLAN RE�7IEW WILL B$ STARTED
(See Check-off List Enclosed)
_..__ ---------------------------
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THE APpZICANT IS: (circle one) O��TNER o CONT.�C�OR
JOB SITE ADDRSSS:
� %��C� �� ,�,/ , � _ - zzP: -�S � i !
�% i-o .� �� .iL2/� (work) � 7�_ �--�s��,�
� � ����� <F"� ���o� << � �- PHONE: (home) 7- �� ��.30
NAMZ: OF OWNER: � � � c' d
MAII,ING ADDRESS: � � Y G' � -�� C�/ /7`v CITY: vi�;� � ZIP: S .j � %/
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� � ��.--� �n PHONE: �� � � �S��
CONTRACTOR: / ,�� c' ��'n `` �-` "`
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MAII.ING ADDRESS:
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STATE LICENSE: # � � Y-5
ARCHITECT/ENGINEER: pH���
MAILING ADDRESS: CITY: ZIP:
N�_ REGISTR�TION �
TYPE OF WORR- New Addition Accessory Structure Move
Demo . Remodel/Alteration Renovate_� Land Alteration
--� �� � �- 7�� �
PROPOSED WORR (describe in detail) : / ��� � �' � G'
.,�%� � C 7`t /c P +�` ��4 7�'�
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STORIES: � SQ. FEET OF EACH FZOOR= ��
C-"' G�-
NO. OF BEDROOMS: �� GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $
I hereby apply for a building permit and I ac?cnowledge that the information
above is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City and with the State Building Code; that I
understand this is not a r it and work is not to start without a permit; and
that the work wil l be in accordance with the p�oved plan. �
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APPLICANT'S SIGNATIIRL?: �� ���'u� �-� J DATE: �
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°:�'_;>:-` Post Office Box 66•Crystal Bay,Minnesota 55323•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 sub eerc�ts� �o�
data", we would like to inform you that your request for a p
Iicense from the City o��ate or conf dent al e nf rmationmay require
y o u t o f u r n i s h c e r t a i n p
You are notified that:
l. The information you furnish will be used to determine your
qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or license.
3. The in£ormation may be shared with °t=ocessCthe permit or
federal. agencies to the extent necessary to p
license.
4. If your requested permit or license requires Councii ac��o%
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6 . Your fuZl name is required to process this application or
permit.
First
Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature
BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE —�373-7358
• PUBLIC WORKS —473-7359
ASSESSING