HomeMy WebLinkAbout1993-005748 - reroof PERMIT
C.��,,�,� F ORONO PERMIT TYPE: ���_:II..G=€�c�
27�0'Keiley Parkway • P.O. Box 815 ��?ti�;'ci,_:
Permit Number: ; � .;��r,M�__,
Orono, Minnesota 55356-0815 Date Issued:
(612) 473-7357
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE�.G/�.
CITY OF ORONO - BUILDING PERMIT APPLICATION
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Total Fee: $ Date Received:
Date Approved:
Entered By: Permitn: `� '75��
AT•T• INFORMATION MUST BS SDBMITTED IN FDLL BEFORE PLAN RE�7IEW WILL B$ STARTED
(See Check-off List Enclosed)
--------------------------
TgE APpI�ICANT ZS: (circle one) O�dNER or CONTRACTOR
JOB SITE ADDR$SS:� ��n/ �lI r�l�C%s "'��'=i�� ivC�'7�-l�f-k�f'� L��- • _ ZIP:
(work)
NAME OF OWNER: �' (f N/�� �,r n, (_'�'l t:� --� PHONE: (home)
CITY: >> �in-,ii�'> --,�J ZIP: ��S4� �-- i�'_4�`�
MATLING ADDRESS:�-' < <� / �� 'r-�' i 7 - — �
CONTRACTOR:�� `,� !c��. �,E' v�'z i b v PHONE:��` -?_" ! `.,
�'oA,s
MAILING ADDRESS:�;''r7/; 't°N7'�[' i��' � /���" CITY:��-'�Il;�; �.�K� F'i>2K ZIP: S��-3C_.
STATE LICENSE: �
ARCHITECT/ENGINEER: PH��
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION n
TYPE OF WORR- New Addition Accessory Structure Move
Demo . Remodel/Alteration Renovate ., Land Alteration
PROPOSED WORR (describe in detail) : � -
STORIES: SQ. FEET OF EACH FLO�R=
NO. OF BEDROOMS: GARAGE STAI.I.S: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (ezcluding land) : $ �OL � �
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 without a permit; and
that the work will be in accordance with the app roved plan.
� � ��� DATE: i'/_/� - %�
APPLICANT'S SIGNATIIRE� : .� =� -..-� ��..
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a %�'1�_='�-�: Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� _ � �. On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. Z, "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
license from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
l. The information you furnish will be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other Iocal , s`ate or
federa3 agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Council. ac��or.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6 . Your full name is required to process this application or
permit.
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First
Middle Last
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Address
c��� : �, C= -� i� r`�,; j��C� ='��
City State Zip
J`�� - �' 3�<-'�
Phone
I understand my rights as stated above.
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BUILD[NG&ZONING—473-7357
• ADMINISTRATION&FINANCE—�373-7358 • PUBLIC WORKS —473-7359
ASSESSIN G