HomeMy WebLinkAbout1993-005691 - overlay/re-roof . PERMIT .
CITY OF ORONO � �' � �` _ _ .
PERMIT TYPE: [
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2750 Kelley Parkway P.O. Box 815 Permit Number: ��a�_3�;Y,=,-;�
Orono, Minnesota 55356-0815 _
(612) 473-7357 Date Issued: 5 i ;f c i�/'=t:=;
SITE ADDRESS:
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FEE SUMMARY:
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APPLIC ITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORON"�"- BUILDING PERMIT APPLICATION
Total Fee: $ y� � ` � Date Received:
Date Approved:
Entered By: � '�'
Permittt: i/
AT.T• INgpRMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WII,L B$ STARTED
(See Check-off List Enclosed)
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TgE APPLICANT IS: (circle one) �'0�+7NER;or CONTRACTOR
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J�B SITE ADDRSSS: � �-� � �• ��� �"�l - �^ �r� �r �
(work) � 7� " i i %%
N�ME OF OWNER: /� � � ��;u�'„i/!�; �y�i�' ��/+-� PHONE: (home) �1`�/ -�%�l `�
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MASLING ADDRESS: � G��' ��✓� � - _ ; �,'� � CITY: " ��<��� � ����'° ZIP: `� -'_ �
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CONTRACTOR: �=�C�_ ; ' - ,-_. -; � , �, , � PHONE: " ✓ -'
MAILING ADDRESS: � CITY: ZIP:
S'.CATE LICENSE: #
ARCHITECT/ENGINEER: PH���
MAILING ADDR.ESS: CITY: ZIP:
N��_ REGISTRATION n
TYPE OF WORR: New Addition Accessory Structure Mave
Demo Remodel/Alteration Renovate Land Alteration
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PR.OPOSED WORR (describe in detail) : � c ;-' i � � \ �'`' � ✓"� ( �- , � '� �J
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S'rORIES: SQ. FEET OF EACH FLOOR:
NIJ. OF BEDROOMS: GARAGE STAI.LS: ATT. DET.
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ESTIMATED CONSTRIICTION VALIIATION (egcluding Iand) : $ �` � "
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 wi�ha�hl
ordinances and codes of the City and with the State Building Code;
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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APPLICANT'S SIGNATURE: G='�i !..! � � �''�'t-�^--�r � „�••.-- DATE: ��
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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. 2, "Rights of subjects of
data" , we would Iike to inform you that your request for a permit or
license from the City o r � ate or conf dent al e nf rmationmay require
y o u t o f u r n i s h c e r t a i n p
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 license.
3. The information may be snared with other local , s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or I.icense requires Councii ac��o%
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 �o proc�ss this application or
permit.
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I understand my rights as stated above.
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Signature —
BUILDING&ZONING—473-7357
• ADMINISTRATION&FINANCE—�173-7358 • PUBLIC WORKS—473-7359
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