HomeMy WebLinkAbout1994-006020 - tear-off/re-roof -
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CITY OF ORONO � '' PERMIT TYPE: �
2750 Kelle Parkwa • P.O. Box 815 �� - - - -
Y y Permit Number: -
Orono, Minnesota 55356-0815
(612) 473-7357 Date Issued: _:6� � - -- _
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: _ ; ,;s ;. . _ . _
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APPLICANT'PERMITEE SIGNATURE ISSUED BY SIGNATURE
CITY OF t�t�-- B�ZDING PERMIT APPLICATION
� -� � • Date Received:
Total Fee: $ �� .
Date Approved: '
Entered By: � Permit Q: � �a 6 . _ . _
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AT.T INgOgMATION MIIST BS SUBMITTED IN FULL BEFORE PLAN REVIEW WII,L BB- SgBRTF.D
(See Check-off List Enclosed)
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� �pZI�T Ig: (circle one) : i�TNE pr CONTR.ACTOR
�y . ZIP: �S� �
Jos si� AnDRsss: y 3 �o Yl o r-�1.. S �o � _
� (work) �7 Y- 3 Z-�c,�
NAI� OF OWNEK: �..c�i I�;a T S LV�o e n � v►� PHONE: (home) Y 7�.—3'7 J`3
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ci�r:�� o c.c ���_____._ zzP: �� 3��I
MAII�ING ADDRESS: �l 3�6 n , S h O rg IO �, _ �
PHONE:
CONTRAC'rOR: �
MAILING ADDRESS:
CITY: ZIP:
STATE LICENSE: �
PHONE: �
ARCHSTECT/ENGINEER: ""
��q: Z IP:
MAT_T ING ADDRESS:
REGISTRATION s
NAM�t
Addition Accessory Structure Move__
TYPE OF WORR: New Renovate Land Alteration__
Demo Remodel/Alteration
PROPOSED WORR (describe ia detail) : �'-- �° ` �' r � �
� Q � � a
STORIES: SQ. FEST OF EBC� FZOOR:
NO- OF BEDROOMS: GAR.AGE ST1�LI�S: ATT. DET.
ESTS�iTED CONSTRIICTIoN VALIIATION (eaclndi_ng land) : $ ���QU�
I hereby apply for a buildinq permit and I ackncwledge that the information
above is ccmplete and accurate; that the work will be in conformaace w thh �hi
ordinaaces and codes of the City and with the State Building Code;
understand this is not a pertuit and work is not to start withvut a pe�it; and
that the wvrk will be ia accordance with the approved plaa- _ . -
�,7 � �/ � �� DATE: . �l�/��9 �.�--
APPI.ICANT'S SIGNATURE:�V.��G�"'-� �•
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� � ���C`�'o� O��I1T�
Post Office Box 66•Crysial Bay.Minnesota 55323•Municipal Offices
!
• _ � � pn the North Shore of Lake Minnetonka _
DATA PRSVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of sub ern�t o=
data", we w o u l d l i k e t o inform you that your request for a P r e u i r e
license from the City af Orono ar any of its depar tmen t s m a y Q
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 witht�oth��r eSscthe permit or
federal agencies to the extent necessary P
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 process this application or
permit.
�.t�� �� �Q v� �� SC. Gl a� v� ic �n Q,- -
First
Middle Last Q
� �� o �or -E �-. S �va�'- �l� •
Address
�1 U Li h P F �vt �V S,! � �y
City State Zlp
�1'] 2 37J3 . �
Phone
I understand my rights as stated above.
�� ���
Signature ' ' • �
BUILDING&Z�NING—473-7357 • ADMIIVISTRATION&FiNANCE—473-7358
� PUBLIC WORKS—473 7359
pSSESSING