HomeMy WebLinkAbout1992-004166 - grading & filling PERr ���T ;
CITY OF ORONO _ �'ERMIT TYPE. ii:_.��;; C�Er I;��"C;
1335 Brown Rd. South • P.O. Box 66 Permit Number: i?'-`��'_°`�
Cr stal Ba , Minnesota 55323 �;i ,�:�;j ;����_
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(612) 473-7357
SITE ADDRESS:
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APPLICANT.iPERMITEE SIGNATURE ISSUED BY:SIGNATURE �
CITY OF ORONO - BUIL��G PERMIT APPLICATION
Total Fee• $ �U< <�� Date Received: �� -3� - � �
Date Approved:
Entered By: /`��'�r /
Permit#: `�� G' S�
AT•T• INFORMATION MUST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed)
--------------------------------------------------
----------------------------- __=-�
THE APPLIGANT IS: (circle one) OWNER or ONTRACTO CoN�li2vc.�rtc.rN ���Au.�.
JOB SITE ADDRESS: 2�a`�� 2`�''3r'' �a�� 2� ZIP:
(work) �113-�3��
NAME OF OWNER: C�� � ��N'� PHONE: (home)
MAIZ�ING ADDR.ESS: P.O. �X (�,� CITY: C2y5�t- 3�y ZIP: `�`�323
CONTRACTOR: �2�vs �N��25o►� ��.5� PHor�: 332-�2g�
MAILING ADDRESS: 525 �• ��" ST CITY: ��1-5 ZIP: `����y
STATE LICENSE: #
ARCHITECT/ENGINEER: ��2�� U`��5 ��`STC 2 PHONE: � 339 ' ���Z
MAII,ING ADDRESS: 2.22 �(i12'�l-1 2Np ��' ' CITY: �P�-5 ZIP- S�� 0\
NAME: ��-� �c�p�2'�'"��r� REGISTRATION #
TYPE OF WORR: New � Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration p�
PROPOSED WORR (describe in detail) : �jITE ��Q�1``�� � ���-�-��'G
STORIES: , SQ. FEET OF EACH FLOOR: 2Co OO� SF
NO. OF BEDROOMS: GARIIGE STALLS: ATT. DET.
ESTIMATED CONSTRDCTION VALIIATION (excluding land) : $ r 2��� ��
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 approved plan.
APPLICANT'S SIGNATDRE: ��� DATE: F -�� --1Z
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C ITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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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
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 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 shared with other local., s�ate or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourse3f.
6. Your full name is required to process this application or
permit.
��ts` l� `����S
First Middle Last
�j2� S U�^ �
Address
(`(1 PLS f�'�r� j5�-t v�-i
City State Zip
�32- �28 �
Phone
I understand my rights as stated above.
``�_��v`r'�
Signature .
BUILDING 8c ZONING-473-7357 • ADMINISTRATION 8c FINANCE-473-7358 � PUBLIC WORKS-473-7359
ASSESSING