HomeMy WebLinkAbout1991-003704 - tearing off/re-roof PERMIT �''�----- ^
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1335 Brown Rd. South • P.O. Box 66 Permit Number: ;�;;;?;�;;j��y�
Crystal Bay, Minnesota 55323 Date Issued: t_}�;;�i� ;�_��
(612) 473-7357
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANUPERMITEE SIGNATURE ISSUED BY:SIGNATURE
R � • ' CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
ALL INFORMATION I�IUST BE SUBMITTED IN FULL BSFORE PLAN REVIEW WILL BE STARTED
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THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: � � • /" �/1� ZIp: ��6�
(work) / �('�'J-5���
✓
N1�ME OF OWNER: �� �G����1'`- PHONE: (h ome) �'4-7 Z-��� g
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MAILING ADDRESS: Iv � � C� CITY: /`�'l�r`� ZIP: ���
CONTRACTOR: � /� PHONE:
MAILING ADDRESS: CITY: ZIP:
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate� Land Alteration
PROPOSED WORK (describe in detail) : � /1 � t
STORIES: � SQ. FEET OF EACH FLOOR: C/DD �,..5� �(,���
NO. OF BEDROOMS: C/ GARAGE STALLS: ATT. DET. �/
ESTIMATED CONSTRUCTION VALIIATION (excluding land) : $ �� J
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 Building Code; that I
understand this is not a Fermit and work is not to start without a permit; and
that the work will be in accordance with the ap�rove� plan.
APPLICANT'S SIGNATURE: DATE: �' �� ' /�j
(Please fil the reverse side of this form)
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°�.��.j�����^� post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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_�_ � ���.�`� On the North Shore of Lake Minneton a
DATA_PRI_VACY 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 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 other local , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some ir.f ormation may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permit.
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First Middle Last
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Phone
I understand my rights as stated above.
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Sig t
BUILIIING&ZONING-473-7357 • ADMINISTRATION R FINANCE-473-7358 • PUBLIC WORKS-473•7359
ASSESSING