HomeMy WebLinkAbout1994-006710 - re-roof/tear-off P�I��✓IIT
CITY OF ORONO PERMIT TYPE: .
2750 Kelley Parkway- P.O. Box 66 �-��_�•-'_=-�-�`� �--
Crystal Bay, Minnesota 55323 Permit Number: t_,:�_,;_,;_';�..;'����
(612)473-7357 Date Issued: -
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT/ F2MITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO -�II���ING PERMIT APPLICATION
� � Date Received:
Total Fee: $ �3� S
Date Approved:
Entered By: •'�-��" Permit tt:�%� d
AT,T• INFORMATION MIIST BS SIIBMITTED II`7 FIILI� BEFORE PLAN REVIEW WI� B$ STARTED
(See Check-off List Enclosed)
-------------------
-------- ,�. ---------------------------
------------------ ....
TgE APPLICANT IS: (circle one) OP7NER CONTR.ACTOR
JOB SITE ADDR$SS: SU On�-1Z-���Up �� _ ZIP:
(work)
NAME OF OWNER: C.�-t��1 ��►v PHONE: (home)
MAII,ING ADDRESS: I�Y� DQ CITY= ���� ZIP:
CONTRACTOR: � 6 r L,v PHONE: �{7 3 -3 3 q 7
MATLING ADDRESS:�S r�-� ( �1 � �� CITY: ZIP: �� r7 �
STATE LICENSE: # �3�
ARCHITECT/ENGINEER: PH���
MAILING ADDRESS: CITY: ZIP:
N�ME: REGISTRATION #
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
� d� o�.SG c �� �� ��"""/
PROPOSED WORR (describe in d�ta11) : �� 1�'h�
�°S�.Sh ��C� �Y' 3a� �� �� l�`=3a� t� � W �lJo, ��
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STORIES: SQ. FEET OF EACH FLOORs
NO. OF BEDROOMS: G�fRAGE STAIaLS: ATT. DET.
W
ESTIMATED CONSTRIICTION VALIIATION (eacluding land) : $
�I��Q �
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 a r ed plan. •
APpI�ICANT'S SZGNATUREs
DATE: I��/ � ( r
a ,` �
� ` ITY of ORON�
C
Post Office Box 66•Crystai Bay,Minnesota 55323•Municipal Offices
•
� _ � � On the North Shore of Lake Minneto�cka
DATA PRIVACY 1�DVISORY
In accordance with M.S. 13•ou/that your request for a perm t or
data",; we would Iike to inform y
license from the City of � ate or conf dential e nfo ationmay require
you to furnish certain pri
You are notified that:
l. The inf orma��i�heYoe�t or Ii ensebrequested. determine your
qualification f P
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 Iocal , s�ate or
f ederal agencies to the extent necessary to process the permit or
Iicense.
4. If your requested permit or Iicense requires Councii ac��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.
� �� s���
irst Middle Last
�aS a�
ddress � ��� �
Cit State Zip
�73 - 33 � �
Phone
I understand my rights as tate above.
i
Signature '
BUILDING&ZONING—473-7357
• ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-�359
ASSESSING