HomeMy WebLinkAbout1992-004386 - tear-off/re-roof PERMIT
� � OF ORONO PERMIT TYPE:
c�+vvn Rd. South • P.O. Box 66 Permit Number: EU I L�I NG
Ba , Minnesota 55323 i yi f�.:;_�t�,
y Date Issued:
,���� 473-7357 �)F./t�:��l'��`
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: � ��
FEE SUMMARY:
VAL�1AT I i±N �r�i ai�
E�as� Fee �17 . ��{�
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T��t.�cl F�� ��i7 . �ia
CONTRACTOR: OWNER:
— Ap��l i��nt. —
I���F�TH '=�H�_!RE Ri il�lF I I�IG � E k��E 14?1__�f�� E,_TER��::E E�L{�I R
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T�iE l�h�IC�EF;=:I�aP�E� H��E��Y F��i,!1E'�:T'�: �'E�;�fI'=�'��Ii��t�[ Tf:� MAF':E THE �E�#,.. I�(F'R��eUEhlEt�T'=�
`=��'EC:I F I ED �l��� A�;�hEE'�= 'I'+� �+i �aLL W�+i;k: I h1 '�7�I C:T C:i�al��'L I aN�:� ��1 I TH ALL C:I T�' �+F
_ �-!��:it�+_� i�t�;C�I�iH�iC:E_� t�4�C� =:1_�d�'E. ��tF h1I �dE���4=1T�? E:t 1 I L�I t�lt� C:CtC1E �;����.s I�iEI��NT'�� . �
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APPLICANTiPERMi ISSUED BY:SIGNATURE
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CITY OF ORONO - BUILDIVG PER'�iIT APPLICATION
Tot�� Fe'�e: $ / �� �v Date Received:
Date Approced:
Entered By: t�3 � �
Permit�:
AT•T• INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL BB STARTED
(See Check-off List Enclosed)
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THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
._ ..-_._. ..__
_ __ _---
JOB SITE ADDRSSS: �7��L`, � �- - E' � 4 �� �'� ZIP:
(work)
NAME OF OWNER: � � , 4� � � •` F PHONE: (home)
MAII�ING ADDR.ESS: �C;�� ' � � : �:,v - CITY: �4��+�--C� ZIP:
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CONTRACTOR: � � - -S>�c -.� ��, , - �= ia' ` PHONE: �-�i/������
�� �-y' Z IP: � ,'=,����/
MAILING ADDRESS: _s�j`�'� �'� `-X c rt r' � � ..� CITY: ��c��- ,•, �l
STATE LICENSE: � �f�% i�-�
ARCHITECT/ENGINEER: pH��'
MAII,ING ADDRESS: CITY: ZIP:
NAME: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure riove
Demo Remodel/Alteration Renovate Land Alteration
_- I,�(1� �
PROPOSED WORR (describe in detail) - / �-� s�� �� `M - �� �'�"�-'
STORIES: SQ. FEST OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STAI.I.S: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ ����. �
I hereby apply for a building 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 Buiiding Code; that I
understand this is not a permit and work is not to start without a permit; and
that the work will be in accordance with the ap oved plan. �
� , �
' / ------- _ __.. /
APPI,ICANT'S SIGNATURE: _ � .,�/ � DATE: C�-��/�t�
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�� � T_ . C�"��' �� O��lOT�
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� ' Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� A _ � �; 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 3.ike 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:
l. 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 Iicense.
3. The information may be snared with other local , s�ate or
federal agencies to the extent necessary to process th� permit or
license.
4. If your requested permit or Iicense 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 full name is required to process this application or
permit.
,
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First Middle . Last
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Address
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C � r�--,�L�r�� ���-i J �v _��
City State Z1p
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Phone
I understand my rights as st ed ab e.
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//� �,_� :�' _ __
ignature .
BUILDIVG& ZON[NG —473-7357 • ADDi1NISTRATION&FINAtiCE — 473-7358 • PUBLIC WORKS —473-7359
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