HomeMy WebLinkAbout1994-006282 - re-roof �
PERMIT
�►��CITY OF ORONO PERMIT TYPE:
27� Kelley Parkway • P.O. Box 815 Permit Number: '_"��=-=''}�`'
Or�� Minnesota 55356-0815 �-''-'�=�''�-_`
(612) 4�3-7357 Date Issued: : ; .
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SITE ADDRESS:
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DESCRIPTION:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE �. �
� � CSTY OF ORONO - BIIILDING PERM.ZT APPZIC�TI�N
` • . Date Received:
'' Total Fee: � , �
Date A�proved:
Entered Bv: Permit= -�.�-L - __
� INgpg.MATION MIIST B$ S7BMITTED IPI FULL B��� P�N �v=� �I'I' BE Sg���
�I' (Ses Check-aff List Enclosed)
�� �PZI�pT Ig: (circle one) O�dNER or CONT.�.ACTOR
� _��,�.� f '7' �.� ZZP:
JOB S2TE A�DRSSS: b /
(work)
` � .�.� PHONE: (home)
J �rti G y��
N� OF OWNF.R: ' �)� ` ''��L��
j ���� CSTY: � ,.�, ,/� ZIP: ,-� ',, ,
MAT_Z�ING ADDRESS�
�G��4 ��G C�
-' � �,��� ,rt-;- (��,�; �1,- _ ; � , � PHorrE:
CONZ'RACTOR: ZIP:��`�'�
� /1 � � CSTY:
MATT,SNG ADDRESS_ �9�S �� � .� �'�}r�
. s C �I 2�6 l0 3/ �C�Prt�� COf?hOf S� �
STATE LIG.NS�. �
PHONE:
ARCHITECT/ENGSNEER:
CZTY: ZIP_
MATI�127G ADDRESS:
R.EGIS�RATION 4
NAME_
,- Structnre riove
Addition Ac�essory
�PE �g p;pgg: New Renovate�_ Land Alteration
D�o ge.*nodel/Alteration
PROPOS� WORK (describe in detail) :
�eea r �- � I�° �'��{ �us�=
STORIES:�_ S4. FEET OF EACH I�LL30Rs
��� STAT,T,S: ATT. DET. _
NO_ OF BEDROOMS:
� ��dz : $ �34� �
ESTSMA� CDNSTBIICTION VALIIATION (esciudin9
b a.p Iy for a buil.ding permit an worJc ill be in conf rmancef with the
` I here y _ P - that the Code; that I
`' above is complete and accurate, and with the State Building e�it; arid
� ordinances and codes of the City
understand this is not a permit and work is not to start without a p
� that the work will be ia accordance with the approved p1�- _ . - �
X � (� DATE: �..,�.�-. ��r I7 r�
:
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` APPI.ICANT`S SIGNATQR.E:
�
� � ��['��' o� ���Ii�'O
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Post Office Box 6&•Crystal Bay,Minaesota 5��•Municipal Offices
� On the North Shore of Lake Minnetonka -
• ' • •
DATA PRIV'ACY AD�SORY
ermit or
In accordance with M.S. 13•ou'that your request for a P�ects1=e
we wou l d l i k e t o i n f o r m Y of its depar t m e n t s m a y r e Q u
data", of Orono or any
licease from the City rivate or confidential information.
you to furnish certain p
You are notified that:
1, The information you furn�ir li ensebrequested, determine your
ermit
qualification for the p require that
2, You may refuse to supply data, but refusal may
the City deny the permit or license.
3. The information may be shared Witht�° p=o�e scthe permit or
f ederal agencies to the extent necessary
?icense.
d, If your requested perir�it or Iicense requires Councii ac��or_
to app=pVe, some information may become public.
�, You have certain rights under M.S. 13.Oa to review private
data on yourself.
6, Your full name is required to process this application or
per,nit.
. ����-1� �:l �Gvl h'1/�Z
�� Middle Last
First
� �� � ��� �
Addres s ��ga 6
1S �'� �
City
State Zip
72�1� ��� .
Phone
I understand my rights as stated above.
� -
Signature
� • PUBLIC WORKS—473 7359
BUILDING&ZONING—473-7357 • ADMINISTRATION&FiNANCE—473-7358
ASSESSING