HomeMy WebLinkAbout1992-004373 - re-roof/overlay ;��ERMIT
CITY OF ORONO PERMIT TYPE:
_ 1335 Brown Rd. South • P.O. Box 66 Permit Number: E���I 1-D I�IG
Crystal Bay, Minnesota 55323 Datelssued: t�{����-j
(612) 473-7357 t)�I(;)�/�i
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: �`� � � ' �'``' '�'r'i '�"�''`''
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THE I�NC�E�:=:IUP�IEC� HEfiEE�Y FiEc;}1������"'�: FERMI'=�'��I=t�Pd T�:i MAE�::E THE REt�L I!"�F'F;+�+UEhfE�lT'��
'1PEC�i F i ED A�4G A�fi�E�� �'+�t !�+� ALL. 4J�+h;k: i!V '�TFt I C:�i� Ca±tt�'L.I A��lC:E W I TH ALL C:I TY i��
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APPLICANT/PERMITEE ATURE SSUEDBY:SIGNATURE ���
CITY OF ORO�"�'"BDILDING PERMIT APPLICATION
Total Fee: $ , • Date Received:
Date Approved:
Entered By:
Permit�: �/ 3 7 3
AT•T• INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE P7�AN REVIEW WII,L BB STARTED
(See Check-off List Enclosed)
----------------------------------------- - -
THE APPLICANT IS: (circle one) OWNER o CONTRACTOR
JOB SITE ADDR$SS: ��� !I/ �• D�1(7 ZIP:
(work)
NAME OF OWNER: �i,�, r�t o PHONE: (home)
MAII,ING ADDRESS: �L��n _ CITY: o.�� ZIP: �
�
CONTRACTOR: PHONE: ��7��L/
MATLING ADDRESS: �� „d��_� CIT�:�-�r��?�✓�_ ZIP:
STATE I.ICENSE: #
ARCHITECT/ENGINEER: P$��'
MAILING ADDRESS: ITY: ZIP:
N�,ME: REGI TRATION �
TYPE OF WORR: New Additio Accessory Structure Move �
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORR (describe in detail) : P-�
STORIES:�_ SQ- �T OF EACH FLOORs ��
NO. OF BEDROOMS: GARAGE STAI.LS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (eacluding land) : $ / �1`� -
I hereby appiy 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 wil 1 be in accordance with the approved plan. •
APPLICANT'S SIGNAZ'QRE: � - DATE: U % "��
�f��
�
C ITY of O1�ON0
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
•
� � � � 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 ta supply data, but refusal may require that
the City deny the permit or license.
3. The inf ormation 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 action
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 ast
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Addr ss
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City State Zip
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Phone
I understand my rights as stated above.
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Signature .
BUILDING&ZONINC—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
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