HomeMy WebLinkAbout1993-005490 - tearoff/reroof ` PEI�MIT .�
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� CITY OF ORONO PERMIT TYPE: _,_��.L!�'a C��;
2750 Kelley Parkway • P.O. Box 815 S':�ii� }��:";
Permit Number: ;.$_�!;_:._;f,_::_;
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued:
SITE ADDRESS: :�;�:_�;:, �:::;����Y` . ,;�_�
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REMARKS:
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APPLICANT�P MITEESIGNATURE ISSUEDBY:5IGNATURE ��c.<.,c�
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- CITY OF ORONO - BIIILDING PERMIT APPLICATIaN
Total Fee: $ �`f-- 15 Date Received:
Date Approved:
Entered By:4,�� Pe�-mit tt: ��`'�c��
ALL INFORMATION MIIST BE SIIBMITTED IN FDLL BEFORE PLAN REVIEW WI� B$ STARTED
(See Check-off List Encl.osed)
--------------------------
THE APPLICANT IS: (circle one) OLdNER or CONTRACTOR�
JOB SITE ADDRESS: �� -[ � K�"�� , J�'� ZIP:
(work)
NAML OF OWNER: �O r l � �� �` � � ' `�� PHONE: (home) 7 � a f
MATLING ADDRESS: ��`� U ��`�'�,C�/ �-e CITY: Nf'�I�� ZIP:
CONTRACTOR: (�
c v►�u.�,f� ` P$o�: � ���33 � �
-7 /� ^ ZIP: S� l �
MAILING ADDRESS: I ! S�� l�� � � c�-� CITY: L i1'�(,1�,�
STATE LICENSE: ,� C���O � 3 5 �
ARCHZTECT/ENGINEER: PH��
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION tt
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
� �f �' �c�s �'�c�,��,�'/�er^ ell�
PROPOSED WORR (describe in detail) : ��r � �� �I�s�
S�lr��-�- ��f��sel��'C'celS�(�1��es N��' ���,.��e�,
STORIES: SQ. FEET OF EACH FLOOR=
NO. OF BEDROOMS: GARAGE STALLS: ATT.✓ DET.
GJ
ESTIMATED CONSTRIICTION VALIIATION (excluding landl : $ �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 permit and work is not to start without a permit; and
that the work will be i ccordance with t roved plan. �
' DATE: ���- 1 �
APPLIC�NT'S SIGNATDRE:
.
.,�,a
�.�_ � �m �`�' o� �ROIeTO
x ,. �I
z�t
:�.: �-����.
_ ;.�.�w
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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• - • s r On th.e North Shore of Lake Minnetonka
DATA PRNACY AD�S ORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
license from the City �f �ate or conf dent al e nf rmationmay require
you to furnish certain pr
You are notified that:
l. 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 license.
3. The information may be shared with oth�ocesscthe permit or
federal agencies to the extent necessary to p
I.icense.
4. If your requested permit or Iicense requires Councii. a��'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 full name is required to process this application or
permit.
� C� � �
First
Middle Last
I �5 �.��" Co� a�
Address � �S�c/ � �
��l�'ls%�.�`� � �
City State Zip
�-�3 -- �3 � 7
Phone
I u stand my rights as st e above.
�
Signa ure �
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS —473-7359
ASSESSING