HomeMy WebLinkAbout1994-006175 - bathroom remodel -
,PERMIT
CITY OF ORONO PERMIT TYPE: �
2750 Kelley Parkway • P.O. Box 815 Permit Number:
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: _�'��� � ;_
SITE ADDRESS: - -_-__.___..-_-_-.
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DESCRIPTION:
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REMARKS: __. _4. .
FEE SUMMARY: ----- _--___---------------------------
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APPLICANTlPERMITEE SIGNATURE ISSUED BY:SIGNATURE
. : _ -
CITY OF ORONO - BIIILDING PER��iIT A.PpI.IC�`iT'ION
• Dat� Rece?ved:
� ��% L�' —
iotal. Fee: � -
Date A�nroved: �
Entered Bv: �-��� Fermit�:�,/ ,��� � � � -__ �
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�Z INgpgM�TION MIIST B$ SUBMITTED IN FIIL-I� BEFORE PLAN R��7IEW WII�L BE Sg���
(Se� Check-off List Enclosed)
_ --- ------(circle one) - Oi�.iER ar CONT.qACTOR
�gg APPLIC�NT I5:
Jos sITE ADDRSss: 1G-�''� t��('t�si �N�'6'e 1���E zIP:
(work)
' PHONE: (horne)
i7AME OF OWN'�:
Ct� ,`�EP�,t,L
CSTY: ZIP:
i�AIZIxG A.DDxEss: /v(rk�-K NEuctY�t .��1 � IS�u /�•tcf�,�E
plws�zr M���
C �5'�I�C(. Ki Tz.cX�'�'s C��Y PHONE: S�' �S�' f�irf'b�k.
CONTRACTOR: �'-��Z 7
C,L�� �• �-h��tu=� ���"( _ cz�: C��'c+�;� l,/,�.�i:Y zzP:
Mp,ZT ING ADDRESS: `
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STATE I�IG`�SE: =
PHaNE=
ARCHZTECT/�G=N�ER:
CITY: ZIP:
MASI�SNG A.DDR.ESS:
FtEGISTR�TION 4
NAME:
Accessory Structsre Move �
Z,.YPE �g wpgg: New Addition Land Alteration
D�o R�*nodel/Alteration
Renovate
,��'C�'�-'� �f�`'ti'L�l_
PROPOS� WORR (describe in detail) :
STORSES: SQ. FEET OF EACH FLOORs
NO- OF BEDROOMS:
G��G� STA7.T,g: ATT. DET.
�� �� . �.-��
EST2MATF.D CDNSTSUCTION VALUATSON (eaclndinq
l�a 1 = $ � �
ermit and I acknowledge that the izsformation
Z hereby agply for a building p . that Z
above is complete and accurate; that the work will be in conformaCn�cdewith t e
ordinances and codes of the City
and with the State Building e�it; and
understand this is not a perntit and work is not to start without a p
that the work will be in acco ance wi the a proved plan. _ • '
/ ......_.-
�/ �" .����
DATE-
APPLICI'�NT'S SIGNATO�:
_ �, � �
` � ����i' o� ����T�
Post Office Box 66•Crystal Bay,Minaesota 5�323•Municipal O�ces
M .
• _
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On the North Shore of Lake Minneto a
DATA PRIVACY AD�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
of Orono or any of its departments may req
license from the CitY rivate or confidential in=ormation.
you to furnish certain p
You are notified that:
1. The information you furnish will be used to determine your
cualification for the pernit or license requested.
1 data, but refusal may require that
2. You may refuse to supp Y
the City deny the permit or license.
3. The information may be snared withtQ P=oc sscthe pe=znit °r
f ederal agencies to the extent necessary
?icense.
a. If your req *' ermit or license recruires Councii ac�=or
ues�ed p become public.
to approve, some information may
5. You have certain rights under M.S. 13.Oa to review private
data on yourself.
6, your ful.l name is required to procass this application or
pe*-mit.
�s� �4'CL� ��'�- �� I�VdC1��'
First
Middle Last
' i.�. ��,r.ct�' l�
Addres s �5t�27
�,�'a�' U �`'iN z�p
City
State `
��- 5�t Sc .
Phone
I und stand m rights as stated abo�e•
v' •
Sign ture �
� • PUBLIC WORKS—473-7359
t3UILD[NG dc ZONING—473-7357 • ADMINiSTRATiON&FiNANCE—473-7358
ASSESSING