HomeMy WebLinkAbout1997-009560 - tearoff/reroof �� 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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REMARKS:
FEE SUMMARY:
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CONTRACTOR: _ . : -- - � ' OWNER:
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� APPLICANT/PE i E IGNATURE , — ISSU D Y:SIGNATURE � 1� �� �
� CITY OF ORONO - BIIILDING PERMIT APPLICATION
�
Total Fee: $ /���� Date Received:
Date Approved:
Entered By: E� permit�: '��<ad
ALL INFORMATION MIIST BS SIIHMITTED IN FDLL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed) �
---------------------------------------------
THE APpI�ICANT IS: (circl.e one) O�VNER or CONTRACTOR
JOB SITE ADDRESS: % % �� �/1�I���i���� �/i��• ZIP: ��,���%
(work)
NAMLr OF OWNER:
`A � PHONE: (home) % � � �
MATLING ADDRESS: � A�'C CITY: G� ZIP: ��3��_
CONTRACTOR• �. �%'�`'�' PHONE: ��.���1 J"�
MATLING ADDRES : ��D� �� ��'• � CITY: C r ZIP: i�/� �����
STATE LICENSE: # %���
ARCHITECT/ENGINEER: +` PHONE:
MATLING ADDRESS: ��' ZIp�
�: REGISTRATION #
TYPE OF WORR: New • Addition Accessory Structure Mave �
D�o Remodel/Alteration�Renovate Land Alteration
�
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PROPOSED WORK (describe i.n detail) :
STORIES:_� SQ• FEET OF EACH FZOOR:
NO. OF BEDROOMS: G�GE STALLS: ATT. DET.
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ESTIMATED CONSTRIICTION V�LIIATION (esclnding land) : $ ���
I hereby apply for a building permit and I acknowledge that the information
abone is complete and accurate; that th rk will be in conformance with the
ordinances and codes of the a w' h the State Building Code; that I
understand this is not a it, is not to start without a permit; and
that the work will be i acco e h the approned plan. •
APPLICANT'S SIGNA
� DATE: �O ��
�
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�I'TY of OROIOTO
Post Office Box Fi6•Crystal Bay,Minnesota 55323•Municipal Offices
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• � � v 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 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 shared with other local. s�ate or
federal agencies to the extent necessary to process the permit ar
Iicense.
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 ar
permit.
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Addr s ���
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Phone
I under nd ights as stated above.
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S g ur � •
BUILDING&Z'�NING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473 7359
ASSESSING