HomeMy WebLinkAbout1991-003739 - reroof caretaker's 1'ERMIT �!
CI��( OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 �i�i i�'����
Permit Number:
Crystal Bay, Minnesota 55323 Date Issued: �}r'�i��'�-'�f
(612) 473-7357
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P ICANTPERMITEE SIGNATURE ISSUED BY:SIGNATURE --
�' ► CITY OF ORONO - BIIILDING PERI�IIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
ALI� INFORMATION lY1DST B$ SIIB1rIITTED Il�i FLTLL Bffi+'ORE PLAN REVIEW i�ILL BE STARTED
--------------------------------------------------------------------------------
T� APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: � �7 D r � Y't� j''� ZIP: � ,S 3��
(work)
Nl�ME OF OWNER: �� � � !/I s PHONE: (home)
IKAZLING ADDRESS: ja�9� CiTY: �/ro�t v ZiP: ,�'S`.3 � �
CONTRACTOR: a �/J �a PHONE:�7.�35-3�
MAILING ADDRESS: o d ?iC_�tJ'� • CITY:� � � ZIP: ��,S-,3/r/
TYPS OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : �
� /�,�J� �
STORIES: SQ. FEET OF EACS FLOOR:
NO. OF BBDROOMS: GARAG$ STALLS: ATT. DET.
$STIMAR'$D CONSTRIICTION VALDATIOa (exclnding land) : $ 2- � �
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 approved plan.
�
APPLICANT'S SIGNATORB: DATE: � /
(Plea 11 out the reverse side of this form)
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C ITY of ORONO
Post Office Box 66•Crystal Bay.Minneeota 55323•Muniapal OfFices
•
o _ � � On the North Shore of Lake Minnetonka
D��� �R�YACY 1�V�SS2R� �
In accordance with M.S. 15.165, "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 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 or license 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 Iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name� and date of birth are required to process
this application or permit.
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Address
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City State Zlp
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Phone
I understand my rights as stated above.
Sign
BULLDiNG&ZONING-473-7357 • ADMINiSTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING