HomeMy WebLinkAbout1994-006140 - re-roof overlay ,
PERIVIIT
� �' O� OF�OIVO PERMIT TYPE:
���u Kelley Parkway • P.O. Box 815 -_��" ' ��'.`.=
Permit Number: - `- - `"'`
Orono, Minnesota 55356-0815 '=''-'=�i'��-`
(612) 473-7357 Date Issued: _ : _ _
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SITE ADDRESS:
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PPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATURE .G�C;
� � CITY OF ORONO - BIIILDING PERMIT APPZICATION
�- Date Received:
Total Fee: $ ���i -5 �
Date A�Drove�: `
Entered By• /'i' Per:nit� �i:%"f�-' _ =
p,T.T. INFORMATION MIIST BR SUBMI eTF,D o f FIILLtBEF�RESe�N REVIEW WI� BE Sg�RTED
(Se_ Ch
i� AppI,ICANT IS: (circl.e one) OS�TNER or CONT_'ZACTOR _
- �..� G ��� �.� � �,�'i r � �.Si z z P: ,_,.5 .S 3� y -
�os sz� �D�ss.
(work)
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N� oF owx�x: ;�? U ,- �, . � > � P$orrE: (home) YT�-..5 Ci�3
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2�iAII,ING ADDRESS: / �G� L'%� �n��s , t.5 �
PHONE: ��7 J - 7/`��'...5
CONTRACTOR: � L� �
J CSTY: ZIP:
MAT�ING ADDRESS: �� � /��`��;,' �>C'
STATE LIC�.C�'NSE: �
(`�-�- � PHONE=
ARCHZTECT/ENGINEER: �
CITY: ZIP:
MATLING ADDR.ESS:
R.EGISTR�TION A
NAMEs
Accessary Structure Move
Z*YPE OF WORR: New Addition Land Alteration
Demo Re.*nodel/Alteration Renovate
� � � ?
PROPOSED WORK (describe i.n detail) : "'
S �3
n
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STORSES:�_ S4- �T OF EACH ��R=
? G�RAGE ST�LS: ATT.�^ DET.
NO. OF BEDROOMS:�,_
ESTS.MI�TED CDNSTRUCTION DALIIATSON (eacludin9
Iand) : $ � � � �•2�
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the work will be in confo� Code;aithatne
ordinances and codes of the City and with the State Building e�it; and
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 plaa.
/, .
� DATEs
APPZICANT'S SIGNATURE-
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N� Post Office Box 66•Crystal Bay, Minaesota 5a323•Municipal Qffices
!
• ' • ' •
On the North Shore of Lake Minnetonka
DATA PRSVACY AD�SORY
In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of
data", we would like to inform you that your request for a permit or
license 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 snared with ot=o�sscthe permit or
federal agencies to the extent necessary to p
license.
a_. If your requested permit or Iicense requires Councii ac��or_
to approve, some inzormation may become publ.ic.
5. You have certain rights under M.S. 13.0a to review priva�e
data on yourself.
6, Your ful.l name is reauired to proc�ss 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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Sign ure �
BUILDING&ZO`11NG—473-7357 • ADMiNISTRAT'IOiV&FtNANCE—473-7358
• PUBLIC`NORKS —473-7359
ASSESSING