HomeMy WebLinkAbout1993-005440 - reroof-tearoff `�� PEI�MIT
��ITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: �`�4�'i�j���''
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Orono, Minnesota 55356-0815 Date Issued: ��;_;/�_;�_�:�;
(612) 473-7357
SITE ADDRESS:
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APPLICANT/PERMITEE SIGNAT E ISSUED BY:SIGNATURE � „(�� �
�, CITY OF ORONO - BUILDING PERMIT APPLICAT30N
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Total Fee: $ .33 ��� Date Received:
Date Approved:
Entered By: iC'-�� • ����U
Fermit tt:
A7•T• INFORMATION MIIST B$ SDBMITTED IN FIILL BEFORE PLAN RE�7IEW WILI� BE STARTED
(See Check-off List Enclosed)
------------------------------------------
TgE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRSSS:� �__`,`�-� `-'// �J �� . ZIP:
(work)
NAME OF OWNER: � C� ��L� ��� �J PHONE: (home)
MATLING ADDRESS: CITY: ZIP:
CONTRACTOR: �i ' S � � �' l:� C_-<���� � PHorr�: �-� 7�"�� �`�
MAILING ADDRESS: S�? 1� ` ��°U�/ :�(.�.�,.�U �LV CITY: E`� -�L�,-�-�j> ZIP: � S ��` l
STATE LICENSE: # S � ���
ARCHITECT/ENGINEER: P$��'
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
� -� rs�---� A Pt:�� �•� :
PROPOSED WORR (d�scribe in detail) : � C I*�� �� � �L � `�
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STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
, =� ` I� '- c�`_�
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl : $_�� `,
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 withvut a permit; and
that the work will be in accord ce with the approved plan. �
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APPLICANT'S SIGNATIIRE: ��' ' ' . �.� ___ DATE: �� - Zi '�"��� .�
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. �`="=' . Minnesota 55323•Municipal Offices
�� - _ Post Office Box 66 Crystal Bay,
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� _ � � On the North Shore of Lake Minnetonka
DATA PRNACY 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
Iicense from 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 ar Iicense 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 , e�i� or
federal agencies to the extent necessary �o process the p
Iicense.
4. If your requested permit or Iicense requires Council ac�ior.
to approve, some infor.nation may become public.
5. 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
permit.
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Address
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City State Zip
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I understand my righ as stated above.
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Sign ure �
BUILDING&ZONING—473-7357 • ADMITYISTRATIO[V&FTIYANCE—473-7358
• PUE3LIC WORKS —473-7359
ASSESSIN G