HomeMy WebLinkAbout1992-004551 - repair lakeside roof , > PERMIT
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PERMIT TYPE: h
1335 Brown Rd. South • P.O. Box 66 Permit Number: �ii i�.�����r' �
Crystal Bay, Minnesota 55323 Date Issued: i;_:I{a7f���L '
(612) 473-7357
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CONTRACTOR: OWNER: — aF°F�� i������ —
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APPIJCAN i PEHMITEE SIGNATURE ISSUED BY SIGNATURE
� ` CITY OF ORONO - BIIILDING PERi�IIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit�:
AT•T• INFORMATION MIIST B$ SIIBMITTED IN FUI�L BEFORE pI,�N REVIEW WII'I' B$ STARTED
(See Check-off List Enclosed)
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THE APpLICANT IS: (circle one) OP7NER or CONTRACTOR
a .
JOB SITE ADDR$SS: � s SC� �����d�✓ ZIP. ��3
(work)
N�ME OF owrl�x:�i�l+�C�S �/Vi fSD�'1J l.�.S�� pso�: chome) �7�:3g'4�
MAIZ�ING ADDRESS: �b(!/ H"��1G� CITY: �'//�U�1� ZIP:
CONTRI�CTOR: ��Q� W I I SO�U PHONE: �7� �15 7`T
MATZING ADDRESS: �1.�� h����rlU/'11�1� _ ci�: �I�/G�f�'�6 zip: S.S G
STATE LICENSE: # ���
ARCHITECT/ENGINEER: PHONE:
MAILING ADDR$SS: CITY: ZIP:
NAME: REGISTRATION tt
TYPE OF WORR: New Addition Accessory Structure Move �
Demo Remodel/Alteration Renovate� Land Al.teration
ibe in detail) : � ' � 'sf��
PROPOSED WORR (descr
�r�fn -
STORIES: SQ. FE$T OF EACH FLO�R:
NO. OF BSDROOMS: GAR�fGE STALLS: ATT. DET.
r /� O('7
ESTIMATED CONSTRIICTION VALIIATION (eacludi.ng land) : $ �5 f���-'/���
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 permit and work is not to start without a permit; and
that the work wil 1 be in accordance with the approved plan. •
APPLICANT'S SIGNATURE: V�/ �''�'�f7�'L- DATE: g �-��
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- CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offtces
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� . � � On the North Shore of Lake Minnetonka
DATA PRIVACY 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
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 Iicense.
3. The information may be shared with other local, s�ate or
federal agencies to the extent necessary to process the permit ar
license.
4. If your requested permit or Iicense requires Councii act=on
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to process this application or
permit.
��1���-`-� ����5 Wt �s o�
First Middle Last
�s� ��������
Address
�D��LI V ' ��N � � �v C 1 � _
City State Zip
� ,/ �— ��7 �
Phone
I unders and my rights as stated above.
Sig ature .
BUILDIIVG&ZONING—473-7357 • ADb11NISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473•7359
ASSESSING