HomeMy WebLinkAbout1992-004297 - reroof-tear off PERMIT
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66BUILDING
Permit Number: 042`9 7
Crystal Bay, Minnesota 55323 Date Issued: 5;0 j/,9
(612) 473-7357
SITE ADDRESS:
:'tet 0 NORTHERN AVE
r:H
N. 7—
DESCRIPTION:
REkOCIF!T EAR OFF
Bui i diiig Perrf it. Type :_;F-ADD/REMC-jDEL
lRu i I rd i r,g We-rk Type RE-ROOF
REMARKS:
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FEE SUMMARY: Ill Ul-' 1,jvv
VALUATION $1509 >Vv:
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Base Fee $1 S . 00 %:iii1 i _ii. i"..iv
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Surcharge —�y�y(a tILLlf f- ffn•iM rLIU
TrJtaI Fee - ` jC �(? iit'-'hrvvs%t% L•VVI !%V.6 1.AV•ii..'
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CONTRACTOR: OWNER: - Applicant -
SLECHTA LEC-1
:ci00 NORTHERN AVE
ORONO MN
47 j-922_:C6;
THE UNDER' I GNED HEREBY REQ1 JE TS PERr•I I'= I a N TO MA�-.:E THE REAL I1~1F'ROVEMENTS*
SPECIFIED AND AGREE" TO C40 ALL WORK IN T I C:T t:t-tMPL I AI' C E WITH ALL CIT`( OF
ORONO ORD I NANr'E' AND f S TATE i+F MINNESOTA 2,t.1 I LD I NG_ C 0CjE REC OU I REMENTS.
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APP C NT'PERMITEE SIGNATURE ISSUED BY.SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $/��.� Date Received:
Date Approved:
Entered By:
Permit#: 4��,C'Z 7
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
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THE APPLICANT IS: (circle one) OWNE or CONTRACTOR
JOB SITE ADDRESS: -3 Z 6 /Ya_?P7`�4 (:312fY W r;r'- w�y���� ZIP: S5-
(work) ' a
NAME OF OWNER: �.��iJ '�.5���-�(f /J PHONE: (home)tr2( ?2Z-&
MAILING ADDRESS: 0 hcoRf( mac I- CITY: Wy ��%A` ZIP: ,5v5-2Q�
CONTRACTOR: PHONE:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration__ Renovate Land Alteration
PROPOSED WORK (describe in detail) : f% R 6 0`= S
STORIES: SQ. FEET OF EACH FLOOR: / 'v f Wr� My PT tfd`S/--
-T
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: �'L—
CITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
0 . 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.
First Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
Signature
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING