HomeMy WebLinkAbout1994-006361 - tear-off/re-roof PERMIT
CITY OF ORONO PERMIT TYPE: -
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2750 Kelley Parkway - P.O. Box 815 L 1" 3
Permit Number-
Orono. Minnesota 55356-0815
(612) 473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTQR., Applicarit.
L I CIOWNER:
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PE—FIE-1) AND AGR(].'.ES TO DO A! L }:}€_l }:. '= .I. C
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APPLI MITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Date Received:
Total Fee: $
" Date Approved: '
Entered By: Permit a:
'f ALL INFORMATION B$ SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
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THE APPLICANT IS:
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JOB SITE ADDRESS_ ��� N
c �� ZIP:
(work)
rPHONE: (home)
NAME OF OWNER: �V-l� � �`-�ca �S /
MATTING ADDRESS:
✓V N � s�� �c� CITY: ,�•-�- _ ZIP:
A !\`�` PHONE:
CONTRACTOR: /� t"u-s � �'
ZIP: 22
MAILING ADDRESS:
STATE LICENSE:
PHONE
ARCHITECT/ENGINEER:
CITY: ZIP
MAILING ADDRESS:
REGISTRATION a
NAME
Structure Move
TYPE OF WORE: New Addition Accessory Land Alteration
Demo Remodel/Alteration Renovate
LA-61-1
PROPOSED WORK (describe in detail) : Cu-S
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ES'1'114ATF.D 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 w that I
ordinances and codes of the City anh the
d 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 accor ce with the approved plan. -
E DATE:
APPLICANT'S SIGNATURE:
CITy of ORONO
Post Office Box 66•Crystal By,Minnesota 55323•Municipal Offices
On the North shore of Lake Minnetonka
DATA Pg MCY ADVISORY
"Rights of subjects of
13.04,
Subd. 2, permit or
in accordance with M.S• you that your request for a P uire
data", we would like to inform Y of its departments may req
license from the City of Orono or any
you to furnish certain private or confidential information.
You are notified that:
The information you furnish i ensell brequesteused d. deteanine Your
1- emit or 1
qualification for the p require that
2. refuse to supply data, but refusal may
the City deny You may the permit or license.
t
be shared with other local, sate or
3. The information may
Process the pert or
federal agencies to the extent necessary to p
license.
4, If your requested permit or license a ublic
to approve, res Council acti°n
some information may be M.S. 13.04 to review private}
- You have certain rights under e
data on yourself.
6.
Your full name is required to process this application or
permit. _
Last
First
Middle
Addre� 3�
State Zip
City
Phone
I understand my rights as stated above.
b
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
PUBLIC WORKS—473 7359
•
ASSESSING