HomeMy WebLinkAbout1995-007087 - reside . �'ERMIT
4 CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 --�� � �-- -
Crystal Bay, Minnesota 55323 Permit Number: - ���
(612) 473-7357 Date Issued: - - _
SITE ADDRESS:
DESCRIPTION:
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FEE SUMMARY: #F:iLUtJa1L� C;;;I� F�`v� �U�:33
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CONTRACTOR: __ . . -��. �c.:_:-:-:�, -- .. - . _.. _"_: OWNER:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATUR �
�t ' ' CITY OF ORONO – BIIIZDING PERM.IT APPI,ICATION
ar
���, �� � Date Received:
:� Total Fe=: $ -
Date A�prove�: � _
: Entered Bv: � ��� — Permit�: �(�D � � - _- -
�.
� BEFORE PLAN REVIEW WLI,I� B8 SZ`BRTED
, �� IggpgriATION MIIST BB`SSUB Ch1"�� ��'s EncI.osed �
. -----------aWiVER o
T Ig: (circl.e one) CONT.LtACTOR
�F� APPLIC�N � ���//
JOB SITE Al7DRBSS:�
� /G � zzP:
� (work)
�� PHONE: (home)
�
r7� OF OWr7ER: �
� �. rl�C CITY: ��(�� ZIP: S�
HAILING ADDRESS: - —
Gt� � ���- a�
l ��s y�ir1'�o�s �-rn� P$��: �f
CONTRACTOR: /� CITY: /V�IUGI ZIP: �S?J/T/
jKpTT ING ADDRESS: ✓JO� /��
STATE LICENSE: � IlI / ��
PHONE:
ARCHSTECT/ENGSNEERs
CITY: ZIPs
MATI.=NG ADDR.ESS:
REGISTFtATION ff
NAME:
Accessory Structure Move �
TyPE OF WORK: New Addition Land Alteration
De�o Re.*nodel/Alteration Renovate
� � l/�
•1) _ ��
PROPOSED WORK (describe in detai.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS:
��� gZ+AT•T•g: ATT. DET.
EST2M.A��D CDNSTRIICTION VALIIATIO
N (eaclnding land) : S ���f) �'✓
I hereby applY for a building p
ermit and I acknow].edge that the inf ormation
above is complete and accurate; that the work will be in cflnform Code;a h t =
f ordinances and codes of the City and with the State Building e�it; and
` understand this is nat a permi and work is n to start without a p
f th ap r ved plaa•------- :. _
, that the work will be in accor ce �
DATE: -'z�
' APPLSCANT'S SIGN�TO'I2E=
,
` �t
�
` � ����' o� O���TO
Post Office Box 66•Crystal Bay,I�tinnesota 5�323•M�dpal Qffices
M •
• pn the North Shore of Lake Minnetonka -
• ' • �
DATA PRSV'AC� ��S�RY
� "Rights of sub j ects of
Subd. 2. ermit or
In accordance with M.S• 13•ou�that your request for a P uire
data", We Would like to inform Y of its departments maY req
licease from the City of Orono or any
Y
ou to furnish certain private or confidential information.
You are notified that:
The information you furnish will be uuested. aetermine your
1. e�-�nit or license req
qualification for the p require that
refuse to supply data, but refusal may
2, You �aY the permit or license.
the City deny
be snared with other local , s�ate or
3. The information may
rocess the permit oi
f ederal agencies to the extent necessary to p
license.
a If our requested permit or Iicense u�e�c res Councii a�='-or
y become p
to approve, some iniormation may
�, You have
certain ri.ghts under M.S. 13.04 to review private
data on yourself.
6 .
Your full name is required to procsss this application or
p e rznit.
��. , �p � �
'�''��"� r d1e Last
First
M�a ��
� �� �
Addres s � �53
a� J Z1P
State
Cit C�,�
/ ~ � .
Phone
hts as ated above.
I unders d �Y g , �
;: .
�
�, .
Si na ure
. • PUBLIC WORKS-473-7359
BUILDING&ZONING-473-7357 • ADMINiSTRATION&FINANCE-473-7358
ASSESSING