HomeMy WebLinkAbout1994-006630 - tearoff/reroof : - PERMIT
� CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: `°���s;���`����'�`-'
Crystal Bay, Minnesota 55323 �-"-4�`='�_�'`-`
(612) 473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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CONTRACTOR: �- . - = _. �.�:�:�-. - OWNER:
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APPLICANT PERMITEE SIGNATURE ISSUED BY_SIGNATURE �
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� CITY OF ORONO - BIIILDING PERMIT APPLICATION
Total Fee� $
�' Date Received:
� Date Approved:
Entered By: Permit#: !�,�(�.3T
AT•T• INFORMATION� MUST B$ S� Che�ckD-offFListBEnOlosed N �I� �� B$ STARTED
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THE APPLICANT I : (circle one) OWNER or CONTRACTOR
JOB SITE ADDR$S : 3�SC� !�/���-h S�n�r � DR ZIP: 5534/
(work)
NAMF? OF OWNEK: PHONE: (home)�7� ��55g
MAII,ING ADDRESS$ 395d No�k Sha� 1?� CIT�= a'aN� ZIP= 5539!
CONTRACTOR: PHONE: oi' �s-O 5� 7
MAILING ADDRESS �CZ,��S $hc�i- C3c�h' Rol _ CITY: /�tir�llln+ c ZIP: 55343
STATE LICENSE: 9��
ARCHITECT/ENGI ER: PHONE:
MAILING ADDRESS CITY: ZIP:
N�: REGISTRATION �
TYPE OF WORR: ew Addition Accessory Structure Move
Demo emodel/Alteration Renovate Land Alteration _
Ft20POSED WORR (c�escribe in detail) : �'-eov GF-F � 1�-0 J4Acr-� �
STORTES: SQ. FEET OF EACH FLOOR=
NO. OF BEDROOMS � _ GARAGE STALLS: ATT. DET.
ESTIMAT�D CONS�DCTION VALIIATION (eacluding land) : $ 3 a 7� a � "
I hereby apply for a building permit and I acknowledge that the information
above is �omplste 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 thisl is not a permit and work is not to start without a permit; and
that the work w�ll 1 be in accordance with the approved plan. �
APPI,ICANT'S SrGI�ATURE: DATE: �i/� l9y
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� NO
C ITY of ORO
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 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 wi3.1 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 witM other local , s�ate or
federal agencies to the extent necessary to process the permit or
I.icense.
4. If your requested permit or Iicense requires Councii act�or.
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to proc�ss this application or
permit.
G~ Middle Last
First
��305 S
Address
1 c �v 5� 943
City State Zip
43S 0557 -
Phone
I understand my rights as stated above.
' gnat re �
BUILDING&ZONING—473-7357 • ADMINISTRATION&F[NANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING