HomeMy WebLinkAbout1992-004574 - regrade _, PERMIT
= CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 ��'_�E�� I�EF I l�EC�
Permit Number: i yt a �
Crystal Bay, Minnesota 55323 Date Issued: c_t;�;/�_�f'��.
(612) 473-7357
SITE ADDRESS:
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F'. I .f�. : f i 3-117-��:-�,:�:-Cii ri yi
DESCRIPTION:
RE�GF�t���}�
tl�er F`��,rr�it• TY��� ��h#L} ALTERATIuN
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REMARKS: .;t1 ��N .50
FEE SUMMARY: �,1���i �� -
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. ,41 GE� .54-
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CpNTRACTOR: - A���1 icai�t• - OWNER:
YER i�;AN �:r�N�=:TRt��:�'�i��� C:+_i 1444�:�:�: Mt j����Hy F::I NCi'=�LEY
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t:F 1'�:� 444-S:i�:i MN ��:;�:
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APPLI NT/P IGNATURE ISSUED BY:SIGNATURE ��
, CITY OF ORO'•i0 - BUII,DI:IG FER.tiLIT APPLIC.ATION
Total. Fee: $ _ �( �"Z Date Received:
Date Appro�ed:
Entered By: ,C/✓
. Pe�iit'�' '��7 ��
AT•7• INFORMATION MIIST BE SUBMITTED IN FIILL BEFORE P?1AN REVIEW WII.L BE STARTED
(See Check-off List Enclosed)
------------------------
THE APPLICANT IS: (circle one) OPTNER o ONTRA '" R
' " � 1� ' C� v z1P: �S�3�i
JOB SITE ADDRSSS s �a�-6 � Iva'"ri► Shc^� ��'�ti E'_ °� �1�-'
(work)
NAML OF OWNER: � n�,s'a...�"�ciY�r�.� l"✓l;�rf�� _ _ PHONE: (home)
MATI,ING ADDRESS: �-��J �i�-�'�� S�v�� �,'���%� CITY: �,�%��7-Ti ZIP: ���'il
i �, PHONE: �'1`�LI�S 3�,3
CONTRI�CTOR: y�r qc� G�� '1 S -
.ti3AILING ADDRESS: 11'�' `7 �x• �S �`7 _ C=�: �54;��f ZIP: ���OL/d
STATE LICENSE: �
ARCHITECT/ENGINEER: PH��"
MAILING ADDRESS: CITY: ZZP:
NAMF: R.EGISTRATION T
TYPE OF WORR: L7ew Addi.tion Accessory Structure rlove
Demo Remodel/Alteration Renovate Land Alteration��
P�OPOSED WORR (describe in detail) : ��,�-,�,v� ���f �,Z 't�fc��'+'� '�i1�� �'��� �r�'r`'�e
d
STORIES: SQ. FEET OF EACH FLOOR-
NO. OF BEDROOMSs GARAGE STALI�S: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding Ia.nd) : $
I hereby appl.y for a building permit and I acknowledge that the information
above is complete and accurate; that the work will be in conforinance with the
�rdinances and codes of the City and with the S�ate Buiiding Code; that I
•�nderstand this is not a permit and work is not to start without a permit; and
:hat the work will be in accordance with the approved pl.an. �
�.P PL I CANT'S S I GNATURE- �� 3 I,l�c--, `--> DATE: �"'I`� �>�- -
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-� C���'o� O�►��TO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
0
s - � v On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would like to inform you that your request for a permit or
license from the City of Orono or any of its departments may require
yau 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 3icense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or license.
3. The inf ormation may be shared with other loca 1, s�ate or
f ederal agencies to the extent necessary to process the permit or
I.icense.
a. If your requested perntit or Iicense requires Councii ac��on
to approve, some information may become public.
5. You have certain rights under M.S. Z3.04 to review priva�e
data on yourself.
6. Your full name is required to process this application or
permit.
(� � i
��l�c e� U �-f,
First Middle Las�
�� " i IJQ�r � 0�
�
Address
T�,�� r��, s5^C��iD
City State Zip
��/4 -535' �
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Phone
I understand my rights as stated above.
�
Signature .
BUILDING&ZOyI�IG—473-7357 • ADSIINISTRATIO[V&FINAYCE—473-73:3 • PUBLIC WORKS —473-7359
ASSESSIYG