HomeMy WebLinkAbout1994-006315 - tear-off/re-roof CITY OF ORONO PERMIT PERMIT TYPE:
2750 Kelley Parkway - P.O. Bax 81-G Permit Number: Bi J T L D 1 P-11,5
Orono, Minnesota 55356-0815 Date Issued:
(612) 473-7357 1 A
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
B.asl_ Fee
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CONTRACTOR: A!.=p 1 i-c a.i-i t ST . OWNER:
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APPLICANT/PERMITEE SIGNAThE ISSUED BY:SIGNATURE
�1 CITY OF ORONO - BUILDING PEMMIT APPLICATION
Total Fee: $ I L� ' y � � Date Received:
Date Approved:
Entered By: Permit /D '3 /5
:
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
-------------------
THE APPLICANT IS: (circle one) O;JNER o CONTRAfC�TOR
JOB SITE ADDRESS: �� U l` \ 15\ Q `� I \ zip:
(work)
NAME OF OWNER: 'A\(' V, 2T3 `nCA PHONE: (home) 44
MAILING ADDRESS: , `O Sl1�Dt.y c)oJ C��T=YZIP: CJI
CONTRACTOR: PHONE: aa --7 lC3 C/
MAILING ADDRESS:a3o0► Sry_�a G S CITY: ZIP:
STATE LICENSE: # r=IO L l
ARCHITECVENGINEERA PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION n
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration_ Renovate Land Alteration
PROPOSED WORK (describe in detail) . �.S1G�"
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 i s comp 1 ete and accurate; that the work wi 11 be in conf ormance 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 he approved plan.
APPLICANT'S SIGNATURE: DATE:
CITYof
ORONO
Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
0
a 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 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 with other local, state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council 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 or
permit.
Ck, - nC+-,
Middle Last
First
Address —
City State ZIP
baa - �71a �
Phone
I understand my ri hts as stated above.
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BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359
ASSESSING