HomeMy WebLinkAbout1993-004901 - soffit & facia PE�MIT
CITY OF ORONO � � s PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: �:�,i j L[}j��i�
Crystal Bay, Minnesota 55323 Date Issued: i�t:��.�+i:i�,
(612) 473-7357 =y� j j '_,i'�_;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER:
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AP ICANT/PER SIGNATURE ISSUED BY:SIGNATURE �Gyd�
*_
CITY OF ORONO - b�J�LD�NG PER�iIT APPI,ICATION
Total Fee: $ �, y� � � Date Received:
Date Approved:
�i>/�
Entered By: u_
Permit,r. .:, �1C �
ALL INFORMATION MIIST BS SIIBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Encl.osed)
--------------------------------------------------
THE APPLICANT IS: (circle one) O��1NER or CONTRACTOR
JOB SITE ADDRSSS: �. �j� ��nr �� �l��l � ZIP: �jLj.� J5L
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(work)
NAME OF OWNER: l,c� � l,� �.�^CJ��LsZ��i PHONE: (home)
MAILING ADDRESS: � �jC �G��'� l�%i._nx�_ CITY:�; t� � i� r'� ZIP: S 5 ���
CONTRACTOR: � i'i1 �V` � PH��'
- � CITY: ( --; �� ZIP:��� 7 �
, MAILING ADDRESS: �7��C,> �YII�� -�J
� STATE LICENSE: #�� � �
ARCHITECT/ENGINEER: pH��'
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION ,ur
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodei/Alteration Renovate Land Alteration
�[ �
PROPOSED WORR (describe in detail) : j�� / / C�' �"-� L-� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
� ,- C��
ESTIMATED CONSTRUCTION VALIIATION (excluding Iand) : $ ���� �
_ 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.
APPZICANT'S SIGNATIIRE: \ DATE:( �
J;
�1`� '� . . . . .
� .'�
� N�
C IT�t'of OlaO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
•
� � � � On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of sub er�t� o�
d a t a", w e w o u l d like to inform you that your request for a p
license f rom the City of Orono or any of its departmen ts m a y r e q u i r e
you to furnish certain private or confidential information.
You are notified that:
l. 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 Iocal , s�ate or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Councii act�or.
to approve, some inf ormation may become publ.ic.
5. You have certain rights under M.S. 13.04 to review priva�e
data on yourself.
6. Your full name is required to procsss this application or
permit.
Fi Middle L
l
dd ess �
( �
City State Zip
`� � �� O 2 C� -
Phone
I understand my rights as stated above.
Si ure �
BUILDING&ZONING-473-7357
• ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
ASSESSING