HomeMy WebLinkAbout1993-005610 - land alteration j PERMIT
�Il`�'� OF ORONO PEFiMIT TYPE:
"z750 Kelley Parkway • P.O. Box 815 Permit Number: �-�� '��` �'�� �fi`���j
Orono, Minnesota 55356-0815 =}`-'�'`'��'
(612) 473-7357 Date Issued: -
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SETE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: �-- ��:���'_ 3. _ =,�-=t� - OWNER:
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APPLICANT%PERMITEE SIGN RE ISSUED BY:SIGNATURE
� - CITY OF ORONO - BUILDING PERMIT APPI,ICATION
Total Fee: $ Date Received:
Date Approved: /0- /Z'Ci 3
Entered By: r��
Permit�: �
AT•T• INFORMATION MDST B$ SIIBMITTED IN FULL BEFORE PLAN RE�7IEW WILL BE STARTED
(See Check-aff List Encl.osed)
-----------------------------
THE APPLICANT IS: (circle one) OG�7NER or CONTR.AC OR
JOB SITE ADDRESS: L < �� � ';x��� � ZIP� ��J S _
(work)
NAME OF OWNER: '�" ��'tS � �� �`r PH NE: (home)
MAILING ADDRESS: �
� cz�: C_.�J zzP:55^3—
CONTR.ACTOR: L�5 PHONE: �G' I I�__�__—
MAILZNG ADDRESS:
� Z CITY: � ZIP:
STATE LICENSE: ,����"
ARCHITECT/ENGINEER: 1�
��-�S �11,L PHONE: � �[Z�5 _
n /�r � ZIP: � Z
MAIZING ADDRESS: I b � t�lk '`��ITY:
NAMF: C S REGISTFtATION # � 1-t -
TYPE OF WORR: New
Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration�_
. � �� ��c��r ��
PROPOSED WORR (describe in detail) . (� G S
t � �O In�o�Q..s
STORIES: SQ. FEET OF EACH FI+O�R=
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VALIIATION (excluding land) : $ ��d�
I hereby apply for a building permit and I acknowledge that the information
above is complete and ac rate; that the work will be in conformance with the
ordinances and codes o he Cit and w' th the State Building Code; that I
understand this is not p i a d wor3c s ot to start without a permit; and
that the work will be i a r n e with he app roved plan.
DATE� l � !��
APPLICANT'S SIGNATURE:
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CI'TY o� ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� _ � � On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accFordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would like to in�orm you that your reques�, for a permit or
license from the City of Orono or any o� its departments may require
you to furnish certain private or confidential information.
�ou are notified that: • " . ;
1. The informa�ion you furnish wil.l be used to determine your
< rqualification for the permit or license requested.
� 2. You may refuse to supply data, but refusal may require that
the City den� tY�e-:.permit or license.
5
3. The information may be shared with other local, s�ate or
federal agencies to the extent necessary to process: the permit or
Iicense. _ .
4. ,If your "requested permit or, become e ub q�2res Caouncii. act�or.
• to approve, some i�formation �ay P
. �,
5. You hav+e certain rights under M.S.i 13.04 to review priva�e
data on yourself. � � . •
6•. Your full name is required to proc�ss this application or
permit.
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First Middle
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City State Zip
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Phone
I u e stand ghts as s ate above.
, i ature •
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• ADMINISTRATION&FINANCE—�73-7358 � PUBLIC WORKS—473-7359
BUILDING&ZONING—473-7357 ,
ASSESSING
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