HomeMy WebLinkAbout1991-003974 - reroof/overlay , ERMIT
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1335 Brown Rd. South • P.O. Box 66 PermitNumber: i:'si=i:_;_i?:�
Crystal Bay, Minnesota 55323 Date Issued: �°=�/�:;�7;��=:�.
(612) 473-7357 ��`��
SITE ADDRESS:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATUR ��C�/
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, � CITY OF ORONO - BIIILDING PERMIT APPLICATION
iotal Fee• $ ����a�' Date Received: ���'<"�%��
Date Appr�ved: >/�,�� i��
Entered By: �,/� , / �j �
� Permit#: � 7' �Z_
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AT•T, INF'ORMATION MIIST B$ SIIBMITTED IN FIILL BSFORE PLAN REVIEW WILL BE STARTED
-------------------------------------------------=-s�--------------------------
THE APPLICANT IS: (circle one) OWNER o CONTRACTOR �
JOB SITE ADDRESS: /7/� /L�� � F;� �,���.�. j�1� I<� ZIP:
(work)
N1�ME OF OWNER: L��; c�-�r� ��v i�/�n�c PHONE: (home)
MAII,ING ADDRESS: / 7/i �s� ��N��.=" ��� ��� CITY: ZIP:
// �-� �� ,--- / ?-
CONTRACTOR: /�n'i'�`l� ��/v r-,� f:n�� ';,�r � X 7�+�I'/c'�('�: �� PHONE: 1/�/` i%,�.L�_
MAILING ADDRESS: ���c:' /V �l�.��r � Kc� CITY: ��c�,l� c� ZIP: �'��i��-�
'I'YPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : ���r���
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOIriS: GA�t1�GE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALUATION (excluding land) : $ /�C'��`' "—r
I hereby app ly for a bui lding permit and I acknowledge 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 Fermit and work is not to start without a Fermit; and
that the work will be in accordance with the aFFroved plan.
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APPLICANT'S SIGNATURE: ''� � _ -�—_ DATE: i'- �n ^���
(Please fill out the reverse side of this form)
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Post Office Box 66•Crystal Bay, Minnesota 55323•Municipa]Offices
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� _ � �_ ��� 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 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
�icense.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5. You have certain rights under bi.S. I5.165 to review private
data on yourself.
6, �our 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 Z1p
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Phone
I understand my rights as stated above.
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�Signature
BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS -473-7359
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