HomeMy WebLinkAbout1992-004707 - old address-1208 �[�, PERMIT
� CI�TY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 ��!����;�����
Permit Number: t��}�.7�7
Crystal Bay, Minnesota 55323 Date Issued: 1 k:3i�f�/'i�
(612) 473-7357
SITE ADDRESS:
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APP�IC NT'PERMITEE SIGNATURE ISSUED BY:SIGNATURE
• �� CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ � � � �� ��� Date Received:
�� Date Approved:
Entered By:_ --� u. -��-
Permit tt. �`� �
AT•T• INFORMATION MIIST BE SIIBMITTED IN FIILZ BEFORE PLAN REVIEW WILL BB STARTED
(See Check-off List Encl.osed)
------------------
------------------ -------------------------------------
THE APPLICANT IS: (circle one) �4NE or CONTRACTOR
'� > l ZIP: S� �3��
JOB SITE ADDRRSS: �c���� ��/�'LYlfl � �/ytc�G4 ��_ ���i�iv�....( ��
(work) � %�-/,2�'j
N� OF OWNER: �O%✓��. f� �� `� �Cc.,l2C;�✓�✓ � • v�� �LL PHONE: (home) �7/- �'c��
MAILING ADDRESS: /�in ;7�iJvt,�l �iui:'f ,���•�. CITY: '�1(OCCii-/�,�_ ZIP: ��7����/
CONTRACTOR: ��-� PH��"
MAII�ING ADDRESS: CITY: ZIP:
STATE LICENSE: ,�
ARCHITECT/ENGINEER: Pg��'
MAILING ADDRESS: CITY: ZIP:
p�E: REGISTRATION �
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate�� Land Alteration
PROPOSED WORR (describe in detail) : ��u,p--V� �'"��-- '�"�-t� �1�� � ��-�`"E���-���"�'�"'`"�'
__ e f U ., �, � • � , � �/�zc / D O'vvr/ �
STORIES: � SQ. FEET OF EAGH FLOOB:
NO. OF BEDROOMS: ..Z GARAGE ST2�I�LS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl : $ �0��• ��
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 wil 1 be in accordance with the approved plan.
APPLICANT'S SIGNATDI2E: �,1(���`�yc� �/ �-��L/G-� DATE: iG /�a - ��
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C ITY of ORON�
Post Office Box 66•Crystal Bay,Minnesota 55323•MuniciPal Offices
•
� _ � � On the North Shore of Lake Minnetonka
DATA PRNACY 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
license 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 license.
3. The information may be shared with other local , s;.ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii act�on
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.
First Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature • �
BUILDING&ZONING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING