HomeMy WebLinkAbout1994-006252 - tear off/re roof - - PERMIT '
� Cil"Y OF ORONO PE�nnrT TYp�:
2750 Kelley Parkway • P.O. Box 815 Permit Number: =``� � �,� � ' ````
Orono, Minnesota 55356-0815 �-�'-��'y�=
(612) 473-7357 Date Issued: {�;,�•�,R��_:;
SITE ADDRESS:
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� APPLICANT/PERMITEE SIGN TURE ISSUED BY SIGNATURE
► �
+ CIT`y OF ORONO - BIIILDING PERxiIT APPLIC.�TION
. Dat� Rece?ved:
Tota1 Fee: $ -
Date A��roved: �
Entered Bv: Permit� - _: -
TION MIIST BS SUBMITTED IN F�L B�a� P�N REVIEW WI� BS S�`�RTED
AT,T. INP�RM� (Se� Check-aff List EncZosed?
-----------------
��APpLICApT Ig: (circle one) OS�ER or CONT.QACTOR
_ 5.�54 Liv; ►.� vs;z;�'= D2_ z=P�
JOB SITE A�D�SS.
(work)
� _ � pgONE: (hcme)
N� OF OWN�s
p � PG;�=-.�2
C• CITY: /JAti�-'��- ZIP:
2��II�ING ADDRESS� 7j���"
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���,�,� ��� PHorr�: �� Z`� - 4-`� z-�
crox: r� Stt�'-�ti fl�9*, �' ' ,
CONTRI� Z IP: �S�-p�o
2,SAII,ZNG ADDRESS: �3 ��
415� �� S Cz�: wl D�S
STATE LIG..QNSE: � � ��
PHONE=
ARCHI�ECT/�GINLER:
CITY: ZIP=
MA7ZING ADDR.ESS_
REGISTRATSON 4
NAME:
Accessory Structure Move
Addition Land Alteration
�PE og �y�gg: New Renovate
D�o R�'nodel/Alteration�_
�r- � f� �l� �G� ` �.(/t✓(�.�i�- �7:�` �i)�=l�'l 4=/,
;t" b�
PROPOS� WORR (desc=ibe in detail) =
�Pt_.�i�� ��-'� ' �' �' �--
STORIESs SQ. FEET OF EACH FLOOR:
NO_ OF BEDROOMS: —
G�R�1GE gTAI,I,g: ATT. DET.
� la.nd) : $ � i�(`:�U
EST�MATED CaNSTRIICTSON VALI7AT20N (eaclnding
ermit and I acknowledge that the information
I hereby agply for a building Pthat the work will be in conformance w hathi
ahove is complete and accurate; Code;
ordinances and codes of the City
and with the State Building e�it; and
understand this is not a perznit and work is not to start without a p
that the work wi11 be in accordance with the apgroved pl.an- _ s
�� -, � DAZ'E: �f�..•� �"��4"
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APPLIC�NT'S SIGNATDF�= 'Y
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- . post Office Box 66•Crystal Bay,Minaesota 5a323•Municipal Offices
rt u' .
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On the North Shore of Lake Minrzetonka
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DATA PRST7ACY A��SORY
a Subd. 2, "Rights of subjects of
Tn accordance with M.S• Z3�ou�that your request for a pe'-"mit or
data" , we Would like �o inform Y of its departments may reauire
".icense from the City of Orono or any
-7ou to furnish certain private cr coniidential inior.nation•
vou are notified that:
l. The iniormation you furnish will be used to dete'-"m'�e Your
cuaiiF�ca�-on for the pe�:n=-� or Iicense requested-
2. you may ref us e to supp ly
data, but resusal. may requi�e that
the ermit ar license.
tne City deny P .
3. The information may be snared w=th ot�oc sscthe Pe'-�1e °r
f ederal. agencies to the extent necessary to p
?icense. , •
yod pe*�it or license requires Counc�I. ac��o%
a. �i your reques�.. become public.
to aporove, some information may
5. You have ceYtain rights under M.S. 13. 04 to review griva�e
data on yourself.
6 . Your full name is recuired to proc�ss this appl.ication or
pe�it.
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�� �� �• �'�� Las�.
First Middle
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Adcress
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State Z1r
City
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Phone
I understand my rights as stated above.
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S � gnature
'cJILD[NG&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING