HomeMy WebLinkAbout1994-006181 - tear-off / re-roof PERMI�.�
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CITY OF ORONO � • � PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: =��_'T L�.}I�`��
Orono, Minnesota 55356-0815 Date Issued: ��f�`'��_��
(612) 473-7357 :;�:, ;�� .•'��
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: OWNER� ���,_._� �:;�_��� ���t. -
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATUFiE
CITY OF ORONO - BQII,DINV��:�=i2T APPI,IC�TION
4� 5 �, . Date Received:
Total. Fee: S � � � -
Date A��roved: '
Entered Bv: ���1�,� - Per_nit�: �� ��� � � _ __
TION MIIST BS SIIBMITTF.D IN FUL.L B�a� P�N �v=� �� BE S�`�T�
AT.T• INP�RMA (Se� Check-aff List Enclosed)
TgE APPLIC�NT I5: (circle one)---aS�E� or CONTRACTOR r
; -� r� �� �D�. vr�,� � Z=P: ��.�w � /
; �
JOB SITE A�DRSSS:
(work) C�� � `���
. ��L� (�� � !� � ,' �� � �� P30NE: (home} "I�U� `T.�� �
NA� OF OWN�- _ �
� � r� ,.� -� l�-7 �z�:�1�'C�(S�a� ZZP: ���.� I.
2�AIZ�SNG ADDRESS� U�� �_
� /� PHONE:
CONTRACTOR:
C=�: Z IP:
MA-LZ�ING ADDRESS:
STAZ'E LIC�.�NSE: �
l.���� P$�NE_
ARCHITECT/�GINEER:
CITY: ZIP_
MAIZING ADDRESSs
REGISTRATION Q
NAME:
Move �
New Addition Accessory StruLandeAlteration
TyPE OF W�RKs Renovate�_
D�o Re.'nodei/Alteration
PROPOSi� WORK (describe in detail) =
��( � ' � �� ! l�c `
STOR=ESs�_ S4- ��T OF EBCB FLOOR:
�Rp,� gTAT.T,S: ATT. DET.
NO. OF BEDROOMS: �
� la.na 1 : S i V l.�(� � ��
ESTIMATED CANST�tIICTION VALUAT20N (eaclndinq
ermit and I acknowled9e that the info�ation
I hereby aoply for a building pthat the work will be in conformance wi�h �he
above is complete and accurate; Code;
ordinances and codes of the City
and with the State Building e�it; and
understand this is not a pez�nit and work is not to start without a P
that the wvrk will be in accordance with the approved pZ�. . ' C�
y '/ � I'�7�� DATE s � � � �
I �{/W !� �-�r
APPI.ICANT'S SSGNATUREs �C
-"�E ,+ti
�� � ���� �� �����
« _ . Post Office Box 66•CrYstal Bay.Minaesota 5�323•Munidpal Offices
•
On the North Shore of Lake Minnetoizka
� _ � • .
DATA PRSVACY ��SORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
our request for a permit or
data", we Would like to inform you that y uire
license from the City of Orono or any of its departments may req
you to furnish certain private or confidential insormation.
You are notified that:
l, The information you furnish will be used to determine your
qualification for the permi.t or license requested.
1 data, but refusal may require that
2. You may refuse to supp y
the City deny the permit ar license.
3. The information may be snared withto p=oc sscthe permit °r
f ederal agencies to the extent necessary
?icense. ,
a, If your requested permit or I.icense requ�res Council ac�=or.
to approve, some information may
become public.
�, You have certain rights under M.S. 13.04 to rev�ew private
data on yourself.
6 , Your full name is required to proc�ss this application or
pennit.
First
Middle Last
Address
City
State Zip
Phone
= understand my rights as stated above.
Signature �
� • PUBLIC WORKS-4�3-�359
gUILD[NG&ZONING-4�3•7357 • ADMINISTRATION dc FiN.�►NCE-473-7358
pSSESSING