HomeMy WebLinkAbout1994-006128 - re-roof garage ' PERMIT
�f�t~OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 -�' �3' ''' r..'i�
Permit Number: =-'`-'�--`�`=�"'=_
Orono, Minnesota 55356-0815 ��-"`='������`=
� (612) 473-7357 Date Issued: t}.`,�:_;,.�;�_;�
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
- ~ � ^ CITY OF ORONO - BIIILDING PERMIT APPLIC�TION
Dat� Received:
Total Fee: S
Date A�nroved: '
Entered Bv' Fer.nit� _ -
A7.T. Il`TpOR24ATION MIIST B$ SIIBMITTED IN FULL BEFORE PLAN RES7IEW WII�L BE Sg�RTED
(See Check-aff List Enclosed) ____�
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i� A.PPLICANT IS s--(circle one) --��'`jE� ar CONT_�ACTOR
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p� ; zzP: �5'S�3S��
J�s SITE ADDRSSSs o�
(work)
� �_._ PHONE: (home) 7`�� �1''� '�Z
N� OF OWNEI2s C �-
CITY:,�� ZIP: ���5'�
MATZ�ING AD)RESS s yi `•� '
PHONE:
CONTRAC'rOR:
- C=�: ZIP:
MAT_T ING ADDR.ESS_
STATE LICENSE: �
PHONE:
ARCHITECT/ENGINEER:
C=�: ZIP:
MAILING ADDR.ESS:
REGISTRATION �
N�ME=
Accessory Structure Move
�yPE OF WORR: New Addition Land Alteration
De�o Re.*nodel/Alteration Renovate
PROPOSED WORK (describe in detail) :
STORSES s S4• FEET OF EACH FI�OOR:
NO_ OF BEDROOMS:
G�RP,GE STALLS: ATT. DET.
ESTIMATE� CDNSTRIICTION VALIIATION (eaciuding
land) : $
I hereby apply for a buil.ding p
ermit and I acknowledge that the information
above is cflmplete and accurate; that the work will be in conform c de With t e
ordinances an d co des o f t h e C i t y and with the State Building e�it; and
un der s t a n d t h is is not a permit and work is not to start wit hou t a p
that the work will be in a darice with the approv e d p l.a n- .
u� s�._ . � �
DATE: '����
APPI,IC�iNT'S SIGNA
.� � � ���1�
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w s Post Office Box 66•Crystal Bay,Minnesota 5a323•Municipal Offices
•
� _ o , o On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
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
crualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be snared with other I.ocal , s�ate or
f ederal agencies to the extent necessary to process the perntit or
Iicense.
g. If your requested permit or Iicense reauires Councii ac��or.
to approve, some iniormation may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yoursel.f.
6. Your full name is required to proc�ss this application or
pe*�it.
First Middl.e Last
Address
City
State Zip
Phane
I understand my rights as stated above.
Signature �
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
� PUBLIC WORKS—473-7359
ASSESSING