HomeMy WebLinkAbout1995-007203 - re-roof/tear-off � ,� . PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 -
Crystal Bay, Minnesota 55323 Permit Number:
(612) 473-7357 Date Issued: - _
SITE ADDRESS:
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DESCRIPTION:
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APPLICA PERMITEE SIGNATURE ISSUED BY:SIGNATURE
� � CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By: permitn: ' � v � �
AT•T• INFORMATION MUST BS SIIBMITTED IN FIILL BEFORE PLAN RE�7IEW WILL B$ STARTED
(See Check-off List Enclosed)
-------------------------------
TgE APPLICANT IS: (circle one) O�dNER or CONTRACTOR
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JOB SITE ADDR$SS: � _ ' ZIP:
� o?(p (� /V , .S `z G/-2 l��- (work)
NAME OF OWNER: � V�� ��a ''� U �-� -
PHONE: (home)�� ^��-� �>��
MATI,ING Annx�ss: �G --�? L� � l� ��_�) cz�: � � �- ��, zzP:
CONTRACTOR: � � �-�c\. '� T�:�` • � ��-� PHONE: 1 l � I ����� -1
MATLING ADDRESS: ���L�� 1'c� ,ll� 1-��'�1�, CI��.� ,�, �. � ZIP:���
STATE LICENSE: # ��C��� �� '�����
ARCHITECT/ENGINEER: PH��'
MAILING ADDRESS: CITY: ZIP:
NAME� R.EGISTRATION ,ur
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteratio�-� Renovate Land Alteration
PROPOSED WORR (describe in detail) : � �' c�� �� ���`�
STORIES:�_ S4• FEET OF EACH FLOORt
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
1C �_
ESTIMATED CONSTRIICTION VALIIATION (ezcluding landl : $ IC��-��'
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. �
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� _ �'z���-�"�--, DATE:�1� �--
APPLICANT'S SIGNATURE:
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������� NO
�.;.� �� - CITY of ORO
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,::� Post Office Box 66•Crystal Bay,Minnesota 55323•MuniaP����
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� _ � � 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 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 i.nformation.
You are notified that:
1. The information you furnish wil.l 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 license.
3. The information may be shared with oth��r e scthe permit or
federal. agencies to the extent necessary to p
license.
4. If your requested permit or license requires Councii ac�io%
to approve, some information may become pubZic.
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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Addrsss
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I understand my rights as stated above.
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Signature
BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING