HomeMy WebLinkAbout1995-006843 - tree removal . , PERMIT
, � �� � Y OF ORONO
' � 2750 Kelle Parkwa P.O. Box 66 PERMIT TYPE:
y y Permit Number: �1��.��.����r-�->
Crystal Bay, Minnesota 55323 - = _ _
(612) 473-7357 Date Issued: - _ _ - _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: -� -- ��
FEE SUMMARY:
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CONTRACTOR: : s_:-:; �:: -- -:� - OWNER:
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PLICANT�PERMITEE SI NATURE ISSUED BY:SIGNATURE
� CITY OF ORONO - BUILDING PERMIT APPLICATION
• Date Received:
Total Fee: $ ��� C Z�
Date Approved :
Entered By: .G�� Perrtit tt: :� �'`�3
AT•T. INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN RE�7IEW WILZ B$ STARTED
(See Check-off List Enclosed)
TgE APPLICANT IS: ( circle one ) O��TNER or CONTRACTOR
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J�B SITE ADDRBSS- �1�`� � `-/�� 4`�C �d � ZIP: SS� 3 � /
(work)
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�r� �l 'y �S/G� ��� �/, PHONE: (home)
NAML OF OWD7ER: _3 j/
MAILING ADDRESS:
Cj,� �Ni�,C�S�C' ���� CITY: ��G'1 U ZIP: � .��
PHONE: y ' � � 3� /�
CONTRACTOR: �I`^^ �ST�,' � � �r� —
�.�7�' � oc.-, �C��G CITY: /�i�j�Cf�/9.-, ZIP: �'�� /� � .
MAILING ADDRESS: � f
STATE LICENSE: T '2���
AFtCHITECT/ENGINEER: PHONE:
MAII,ING ADDRESS: _
CITY- ZIP:
N�_ REGISTRATION �
TYPE OF WORK: New Addition Accessory Structure
N1ove
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in �ietail) :
�.o .,x/ �,1� nZ �-c/. l�D�-�.. %�i�f � � u /� �'
,� ��� S �C� �'bf.��-� G��r ���4-/"��4� L �91 f- Sv-.., -. r�- t c.., c
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D i'�-r�'•'' i S ��l��.r11 0� � r'r!�-� � l!S- d�r^-o:..r� dS r�''' .1-�- t- /",�la?-•_-s �--�--�
STORIES: SQ. FEET OF EACH FLOORs
NO. OF BEDROOMS: GARAGE STAZ.LS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (excluding land) - $
I hereby apply for a building permit and I acknowiedge that the information
above is complete and accurate; that the work will be in conformance wi�hathl
ordinances and codes of the City and with the State Building Code,
understand this is not a permit and work is not to start without a permit; and
that the wvrk will be in accordance with the a p roved plan.
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APPLICAN
T'S SIGNATURE: DATE:�
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;��' ,��.,„ s '�� Post Office Box 66•Crystal Bay, Minnesota 5a323•Municipal Offices
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� _ � o On tize North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
license f rom the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
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 information may be shared with oth��r esscthe permit or
federal agencies to the extent necessary to p
Iicense.
4. If your requested permit or Zicense requires Councii ac��or.
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 full name is required to process this application or
permit.
�/��-, � OSTIi,�
First
Mi le Last
%S7 � �o� � �, � �( qo
Address
4 �,�� -, �. .� S�s� 31' S'
City State Zip
�=� � � - 3� //
Phone
I understand my rights as stated ove.
��
Signature
BUILDING&ZONING-473-7357
• ADMINISTRATION&F[NANCE-473-7358 • PUBLIC WORKS -473-7359
ASSESSING