HomeMy WebLinkAbout1991-003802 - retaining wall 1 .4 PERMIT
CITY OF ORONO PERMIT TYPE: C:T
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1335 Brown Rd. South - FO. Box 66 Permit Number:
Crystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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. .CIHINING WALL
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FEE SUMMARY: cof",14 71Ac.
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee : $ �' ' S Date Received:
Date Approved
Entered By: �i
Permit #. 7 d `2
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
--------------------------------------------------------------------------------
THE APPLICANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: 7,/ t/VD `�i _S`Z ZIP:
(work)
NAME OF OWNER: PHONE: (home )
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: C= C 6 PHONE: q�� ' Z2 T
MAILING ADDRESS: ZIP: 34-7
o c"&4_ .
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration_
PROPOSED WORK (describe in detail) : PL-) jja F�M�I I N I k)�;k L"A(-L
I2-2� L25W SIT ttl4tfz.--I� 22 62- PtL2 � IDIS 0ATF-.
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $
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 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 will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: � 1�_
(Please f ' l1 out the reverse side of this form)
i
......... ........ CITY®f ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323+Municipal Offices
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® _ ® On the North Shore of Lake Minnetonka
In ccordance with M.S. 15.165, "Rights of subjects of data", we
would l�ke 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.
Yo are notified that:
1. The information you furnish will be used to determine your
qu lification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that
th City deny the permit or license.
3. The information may be shared with other local, state or
fe era l agencies to the extent necessary to process the permit or
li ense.
4. If your requested permit or license requires Council action
t approve, some information may become public.
5. You have certain rights under M.S. 15.165 to review private
d to on yourself.
1
61 Your full name, and date of birth are required to process
tiis application or permit.
First Middle Last
Address
ity State p
Phone
understand my rights as stated above.
7gn—iture-
BUILDING
& ONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
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