HomeMy WebLinkAbout1993-004989 - re-roof PERMIT
CITY OF ORONO PERMIT TYPE: �'f j��_����_'
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1335�rown Rd. South • P.O. Box 65 Permit Number: �_�::;{�_,__����:=;
�t'Fystal Bay, Minnesota 55323 Date Issued:
t612) 473-7357
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APPLICA T;PERMITEE SIGNATUR ISSUED BY:SIGNATURE ��'J��\
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CITY OF ORONO - BUIZDING PER�IIT APPLICATION
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�' ; �� �� Date Received:
��_ Fee: $ �� � ' �
� Date Approved:
ered By: .t`'1�' Permit tt: -- � `,�%
, INgpRMATION MIIST B$ SDBMITTED IN FIILL BE�'��Se� �I� �I'I' B$ STARTED
(See Check-off List ____________
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; APpI�ICANT IS: ( circle one) OP7NER o CONTRACT�R)
n1 �/ ZIP:
3 SITE ADDRSSS: '�U�� �`� � S��o r z �i" �
(work)
� /�e �e r So,-i PHoxE: (home) `-�� I _ ���/
+� OF OWNER: �
ILING ADDRESS: ��� �J' /L� � o r� ��� _ CITY z (J r c'�'1 o ZIP:
'l.,h l�t r/'j 0.✓l �X-�21"i��s ��1 C PHONE: l 7�1 ' � l I �
NTR.ACTOR: �� D � S�3 �c
SII.ING ADDRESS- (D�( o i I�"' �2- C I T Y: i'��G�� r �`7`n ZIP: /
'ATE LICENSE: # / v� c�
PHONE:
:CHITECT/ENGINEER:
�ILING ADDRESS:
CITYt ZIP:
REGISTRATION �
aMR:
Addition Accessory Structure Move �
YPE OF WORR: NeW Renovate Land Alteration
� Demo Remodel/Alteration �
ROPOSED WORR (describe in detail) : �er-o� �
�TORIES: SQ. FEET OF �� ��R:
f0. OF BEDROOMS: GARAGE STA�LS: ATT. DET.
3STSMATED CONSTRIICTION VALIIATION (excluding land) - $ � � �S -
-C hereby apply for a building permit and I acknowledge that the in forma tic�
�bove i s comp 1 ete and accurate; that the work wi 11 be in conf ormance wi�ha�h
�rdinances and codes of the City and with the State Building Coermit; ar:
understand this is not a permit and work is not to start without a p
that the work wil 1 be in accordance with the app roved plan.
APPLICAr7T'S SIGNATIII2E:
�%'< �(:� � DATE: � � � � ��
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�t
_ � �� �'
�r�� � r �I'��i' O� OROl\+ O
L Post Office Box 66•Crystal Bay,Minnesota 55323•MuniciPal Offices
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s _ � � 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
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 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 local , s�ate or
federal. agencies to the extent necessary to process the permit or
license.
4. If your requested permit or Iicense requires Councii. 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 proc�ss this application or
permit.
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��1�,� r��c n ��S_ �l��
First
Middle Last
�c,�;.� C�tv � Ci
Address
/� � �—���,�
���� � �� �� ���i� � ��_� �
� .,�
City
State Zip
��J � � ��/ C,
Phone
I understand my rights as stated above.
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Signature • �
BUILDING& ZONING—473•7357
• ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359
ASSESSING