HomeMy WebLinkAbout1994-006299 - 60 mill rubber roof �ERMIT
CITY OF ORONO � '� PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: � �i`-;�-L�#�£`��'
Orono, Minnesota 55356-0815 - - '���'
(612) 473-7357 Date Issued: :;;�,,i+��,;;�
SITE ADDRESS:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
�. CITY OF ORONO ` BUII�DING PERMIT APPI�IC�TION
� +� - .-,�
� a-� Date Received:
" Total Fee: $ � � -
� Date Approved: '
'- ' �,� / pG� . .
� Entered Bv: Permit�: (Do2 7 / _ . : .
3 . • _ - .
� � '
� gLL II�]gORMATION MIIST BS SUBMITTED II'7 FLTLZ BEFORE PLAN REVIEW WIT�L B$ S2`BRTED
F (See Check-off List Enclosed) __________
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� � p,ppLICANT I5: (circle one) O�ri'NER or CONT_RACTO
F - �n �C9 �l. v'fYi �, zzP:
JOB SITE ADDRBSS.
� (work)
�� �� G � PHONE: (home)y, 7`7"�V zi
�IAME OF OWNER s �
� !I/ fT Y'h'I.f"C—_— � � ZIP:
CITY. v'D�i/'/�
R(ATLING ADDRESS: %�� �
aD� c PHONE: /�� / �
CONTRF�C'rOR: " y� l
j�ATT•ING ADDR.ESS: �II-/�� w Q- i!' ��/u�TY: /Y(D/�— ZIP:
ST�STE LICENSE: � � � � �
PHONE:
ARCHITECT/ENGIN�ERs
CITY: ZIP:
MAIZING ADDRESS:
REGISTRATZON 4
NAME:
Accessory Structure Move �
TypE OF WORR- New Addition Land Alteration
De�o Re.*nodel/Alteration Renovate
PROPOSED WORR (describe in detail� =
L� .r'1 s� 't��t—�
. � ,
STORSES: S4• FEET OF EBCH FLOOR:
NO. OF BEDROOMS: G�iRAGE STAI�LS- ATT. DET.
d �
. /�� / �_
g,STT?�tA�g.D CONSTRIICTION VALIIATION (eaclndin4 land) : $ � �f
' I hereby appl-Y for a buildinq p
ermit and I acknowledge that the information
� above is complete and accurate; that the wark will be in conform Code;a that =
ordinances and codes of the City and with the State Building e�it; and
understand this is not a permit and work is not to start without a p
� that the work will be ia accordance with the approved pla.a. _ - .
� �
� � DATE: "�
� APPLICANT'S SIGNATDF�s
r� - �
` � C���.' o� ���TiT�
Post Office Box 66•Crystal Bay,Minaesota 55323•Municipal Offices
� On the North Shore of Lake Mirr.netonka -
• ' • •
DATA PRIOACY ��SORY
� "Rights of subjects of
Subd. 2� ermit or
13.04, uest for a p
In accordance with M.S• ou that your req uire
data", we would like to inform Y of its departments may req
Iicense from the City of Orono or any
Y
ou to furnish certain private or confidential information.
You are notified that: �
The inf ormation you f urnish i ensebrequested, aetermine your
l. ez-.nit or 1
aualification for the p require that
refuse to supply data, but refusal may
2, You �aY the permit or license.
the City deny
be shared 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 f aur requested permit or license rhequC res Councii. a��'°r
I Y become p
to approve, some information may
- You have certain rights under M.S. 13.04 to review private
�.
data on yourself.
6 , Your full name is required to p
roc�ss this appl.ication or
rmit. �
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First
Midd ,
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Address � 3
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Ci�y
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Phone
I understand my rights as stated abone•
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� Sign re
. � PUBLIC WORKS-473-7359
gUILD[NG&ZONING-473-7357 • ADMINISTRATlON&FINANCE-473'7358
ASSESSING