HomeMy WebLinkAbout1993-005579 - re-roof T- _ _ _ .
PEI�MIT
,� �GI�Y OF ORONO PERMIT TYPE: I
2750 Kelle Parkwa • P.O. Box 815 r:s":-�j�;�'�-`
y y Permit Number: i;i::��7�� ,'
Orono, Minnesota 55356-0815 Date Issued: i i;/i�=i�::;-;
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLI A /PERMITEE SIGNATURE �� ISSUED BY:SIGNATURE
_ -•• , CITY OF ORONO - BUILDING PERMIT APPLICATION
� c�'
L v Date Received:
Total Fee: $ � �l � �" —
Date Approved:
Entered By: permit�:
AT•T• INFORMATION MDST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILI+ B$ STARTED
(See Check-off List EncI.osed)
------------------
THE APPLICANT IS: (circl.e one) OWNER o CONTRACTOR
JOB SITE ADDRSSS: OG G U d-� /lU ZIP:
(work)
NAME OF OWNER: � +�� � ��L. I �� PHONE: (home) _
MAII�ING ADDRESS: /d a� -� ��I79 di J/�� CITY: O/�0�0 Z IP:
CONTR�CTOR:
' � //1/ �(/ psor�: S/�.�.��-�`��
IKAILING ADDRESS: � �� � ' ' CITY� IJG ✓� p'�`'}D7 7
STATE LICENSE: # C�`���`�� �—
ARCHITECT/ENGINEER: /V��'/.� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTItATION �
TYPE OF WORR: New Addition Accessor Structure Move
Demo RemodeZ/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) :
STORIES: SQ. FEET OF EACS FLOOR=
NO. OF BEDROOMS: GAR�fGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding land) : $
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 ap oved plan. �
� DATE:
APPLICANT'S SIGNATORE:
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CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•MnniciPal Offi�es
•
� � � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of sub e��t or
data", we would like to inform you that your request for a p
license f rom the City of Orono or any of its departments may require
you to �urnish certain private or confidential information.
You are notified that:
1. The information you furnish wil.l 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 3.oca1 , state or
federal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Council act�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. �
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First Middle Las
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Ad ress ^
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City ^ State Zip
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Phone
I understand my rights as stated above.
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ign re �
BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSiNG