HomeMy WebLinkAbout1993-005451 - reroof-tearoff� �` �EI�MIT �---
CITY OF ORONO PE�MIT TYPE:
2750 Kelley Parkway • P.O. Box 815 `�'j��_�����C=
Orono, Minnesota 55356-0815 Permit Number: ;:;�;_.T�!
(612) 473-7357 Date Issued: ;�;i,�f,_,._,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY: ' ' ` '
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APPLICANTiPERMITEE SIGNATURE "' ISSUED BY:SIGNATURE � P� ,
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CITY OF ORONO - BIIIZ�DING PERMIT APPLICATION
Total Fee: $ /� -� v Date Received:
Date Approved:
Entered By: .C'Lv
Permit#: J`�S J
ALL INFORMATION MIIST B$ SIIBMITTED IN FULL BEFORE PL�fN REVIEW WII.L B$ STARTED
(See Check-off List Encl.osed)
---------------------------
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THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDR$SS: �`6 b /7�� Z����- �"� ZIP:
(work) ���!745`�
NAML� OF OWNER:
��✓Z.b �.ti� ��i�' G��/� PHONE: (home) �3'"?-3/ 7
MAII,ING ADDRESS: I�b �� SGLS�ln1 � 1��-v CITY: �T� ZIP: ���5
CONTRACTOR: ��f'`��_
psoxE: �f 2�� 7 �-1 O
1KAII.ING ADDRESS: �f� �' � l�� �2uJUv'� f�� _ CITY: �!l�(J�(-�.�� Z IP:
STATE LICENSE: # ��
ARCHITECT/ENGINEER: N/i-' PHONE:
MAII,ING ADDRESS: CITY: ZIP:
N�: REGISTFZATION #
TYPE OF WORR: New Addition Accessory Structure Move �
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : R� �S Lc� �yti.-L �-� � --
STORIES: � SQ. FEBT OF EACH FLOOR: b ��
NO. OF BEDROOMS:�_ G�RAGE STALLS: ATT. DET. �
ESTIMATED CONSTRIICTION VALIIATION (ezcludi.ng 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 Building 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 app=oved plan. •
. � �a�-��
APPLICANT'S SIGNATURLr: � DATE.
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CITY of OliONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� _ � � On the North Shore of Lake Minnetonka
DATA PRNACX ADVISORY
In accordance with M.S. 13.04, Subd. Z, "Rights of sub e��t or
data", we would 3ike to inform you that your request for a p
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 wil.l be used to determine your
qualification for the permit or license requested.
2. You may refuse to suppl.y data, but refusal may require that
the City deny the permit or license.
3. The inf ormation may ben�hneces aryhto processcthe permit or
federal agencies to the exte
license.
4. If your requested permit or license requires Councii ac��or_
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 ful.l name is required to proc�ss this application or
permit.
j���.b s.ti�` /s, ��1����./
First Middle Last
� � �
�s s�� � �.�
Address
�1/l 7✓l�� /�t�1 v�/ ���� �l�-
City State Zip
��� � �?3�- 33� �
Phone
I understand my rights as stated above.
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Signature � '
BUILDING&ZONING—473-7357 • ADMIIVISTRATiON&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING