HomeMy WebLinkAbout1992-004778 - add/remodel PERMIT
CITY OF ORONO PERMIT TYPE: —
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1335 Brown Rd. South - P.O. Box 66 Permit Number: C)A 7 7 R',
Crystal Bay, Minnesota 55323 Date Issued: .':=i. .;`::•-7.
(612) 473-7357
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FEE SUMMARY:
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APPLICAPTT/PERMITEESI- JATLJRF ISSUED BY:SIGNATURE
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CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ C , D Date Received:
Date Approved:
Entered By: Permit#:
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) OTINER or CONTRACTOR
a
Jos SITE ADDRESS: 018 ®�� ZIP: SSaS9 I
pp _� (work)
NAME OF OWNER: PHONE: (home)
MAILING ADDRESS: Sante CITY: ZIP:
CONTRACTOR: +�k 5� ce �S^" , PHONE: 4?4 -
MAILING ADDRESS:4,4 oo CITY: M o ZIP:
STATE LICENSE: # t),DO S 4 9 2
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
Nom: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate ✓ Land Alteration
PROPOSED WORK (describe in detail) . .�. �+ ori `K'1 12521
STORIES: 1 SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $ 1a00 Ob
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 acc rdance with the approved plan.
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APPLICANT'S SIGMA DATE: 2--
e,
CITY of ORONO
Post Office Box E 6•Crystal Bay,Minnesota 55323•Municipal Offices
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e . On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISOR
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 confidenti 1 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 maybe
ent necessashared 1 hother to processcal, state or
the permit or
federal agencies to the e
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 ast
Address
City State 3-P
Phone
I understand my rights as stated above
Signature
BUILDING&ZONING—473-7357
• ADMINISTRATION&FINANCE— 73-7358 • PUBLIC WORKS—473 7359
. ASSESSING