HomeMy WebLinkAbout1994-006014 - re-roof � ! ' . PERMIT
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�ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 `��-�= � �--
Orono, Minnesota 55356-0815 Permit Number: _ _;�,:$�`�"`��
(612) 473-7357 Date Issued: `��� y:
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SITE ADDRESS:
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'� � �/n�C�a-� �
� A CANTiP MITEE SIGNATURE ISSUED BY SIGNATURE
� � � CITY OF ORONO - BIIILDING PERMIT APPLICATION
� S� � � � Date Received:
Total Fee: $ �
Date A�oroved: �
Entered By: � `` — ��/� � � - -
Permit Q:
g�L IgpOgI�iATION MIIST B$ SiTBMIT�ED II`7 FIILZ BEFORE PI.AN REVIEW WII�L B$ SgBRTY.n
(Ses Check-off List Enclosed)
Tgg p,ppI,2CANT I5: (circle one) O��7NER o CONTR.ACTOR
c �� Ual' ZIP: ���
JOB SIT� ADDRSSS: � /'-�,�'�7�-
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�.7 !�(�/ PHONE: (home)
:i� OF
o�: �l �� .
I"iAILING ADDRESS: ���
CITY: � ZIP:
��L�� - PHONE:
CON�CTOR:
MAII.IN,G ADDRESS:
�,�ME CITY: ZIP: _
STAZ'E I.ICENSE: �
PHONE:
ARCHSTECT/ENGINF.F,R:
��: ZIP:
MAILING ADDRESS:
REGISTRATION a
N�:
Additian Accessory Structure Move �
TYPE OF WORK: New Renovate Land Alteration__ f
Demo Re.*nodel/Alteration I
�t� �o��' �- ' �/� G���`l �S �'
i 7�? �
OPOSF•D WORK describe i.n detail) : �� �
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� ` -- 1�f I ( �e� �,�c�� �,� o
-�--i�1 s . w�ea Q�Gt�`q
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STORIES: SQ. FF•BT OF EACH FLOOR:
NO. OF BEDROOMS:
GpiRAGE ST�LS: ATT. DET.
�o
ESTIMI�TED CONSTRIICTION VALIIATION (eacinding land) : $ ���C�
1. for a building permit and I acknowledge that the iaformation
I hereby app y
abvve is complete and accurate; that the work will be in conformance w th t i
ordinances and codes of the City and with the State Building Code;
understand this is not a permit aa work is not to start without a permit; and
that the work wiI 1 be in accord 't th roved plan. _ '
1 DATE:
.� � �
APPLICANT'S SIGNATUItL�:
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� � �����
C�'�'� o .
Post Office Box 66•Crystal Bay.Minnesota 55323•Municipal Qffices
!
� _ � � On the North Shore of Lake Minrcetonka _
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of sub er�� Q�
data", we w o u l d l i k e t o i n f o r m you thof itsrdeeart en t rma y r e q u i r e
l i c e n s e f rom the City of Orono or any P
you to furnish certain private or confi den tia l in f o r i n a t i o n.
You are notified that:
l. The infor fo ltheypermit or li ensebreque ted, determine your
qual.ification
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 witht�oth=�r eSscthe perntit or
federal agencies to the extent necessary P
3.icense.
4. If your requested permit or license requires Councii ac�ior.
to aporove, some information may become public. �
�. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required to proc�ss this application or
pe*mit.
� Q� � � \i v`
Fir l iddle
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'dre s
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City State Zi
�
Phone
I understand m g s stated -
Signature � ' �
BUILDING&ZONING—473-7357 • ADMINISTRATIOiV&FINANCE—4�3-7358
• PUBLIC WORKS—473 7359
pSSESSING