HomeMy WebLinkAbout1991-003753 - land alteration �'ERMIT�
CI��Y OF ORONO PERMIT TYPE: t�==;E�; C,EF IhIEG
1335 Brown Rd. South • P.O. Box 66 PermitNumber: t}�j:�7�:�
Crystal Bay, Minnesota 55323 Date Issued: C����17/'=�1
(612) 473-7357
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: -- AF���I i c ai-�t. -- OWNER:
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APPLICANT/PERMITEE SIGNATURE � ISSUED BY:SIGNATURE
, CITY OF OR01�10 - BIIII,DING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
ALL INFORMATION IYIDST B$ SOBIKITTED II�1 FOI.L BBFORE PLAN RRVIEW i�ILL BE STARTED
----------------------------------------------------------------------------
TH$ APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITS ADDRESS: //�-I� Nvi2TH Aiz✓YI ?JiZ� ZIP: ��3CO`'(
(work) $�r - $�t�`f
NAME OF OWNER: ��m �73;Z.o PHONE: (home) �/7�- y S 5�
MAILING ADDRBSS:J/�-1� Ncu2 "/� �4�Z.vv� ]�jZ CITY: /'Yl d�� �•r� ZIP: S 5 3� `�
CONTRACTOR: �c��`t G �2�� �'X c'RV A�� N G PHONE: �172 ' / 75 7
MAILING ADDRESS: YB�o V�� N�� �'�'�V�'�S �� CITY: i'1'lv���� ZIP: S53�y
TYPE OF WORR: New Addition Accessory Structure MoveT_
Demo Remodel/Alteration Renovate Land Alteration�_
PROPOSED WORR (describe in detail) : T rhP,Zv�� �,2,�� ,uAc.� A��u Hs�.
t-�w� A�� �_/l�'+`��'� (38.RnJ`
STORIES:�_ SQ. FEET OF EACH FIAOR: Co�o �
NO. OF BEDROO1rIS: Z GARAGE STALLS: ATT. DET.�_
:X
SSTIMAT$D CONSTRDCTION VALIIATION (exclnding land) : $ So�p
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 Fermit and work is not to start without a permit; and
that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATORE: � DATE: �� /�'R�
(Please fill out the reverse side of this form)
.
�
CITY of ORONO
Post Office Box 66•Crystal Bay,Minneaota 55323•Mnnicipal Offices
•
� _ � � On the North Shore of Lake Minnetonka
D.��� T'R�.C__�.�.�� �
In accordance with M.S. 15.165, "Rights of subjects of data", we
would like to inform you that your request for a permit or license
f rom 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 license 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 , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permit.
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I understand my rights as stated above.
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