HomeMy WebLinkAbout1991-003832 re-roof PERMI7��i
CITY OF ORONO PERMIT TYPE: �;��j��y3��;
1335 Brown Rd. South • P.O. Box 66 � � J Permit Number: �j�-}�-��-==�i
Crystal Bay, Minnesota 55323 Date Issued: `��t�`��'���
(612) 473-7357
SITE ADDRESS:
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APPLICANT/PERMITE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO - BUILDING PERMIT APPLICATION
;� . ,,,
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
AT•T• INF'ORMATION IYIOST B$ SIIBMITTED IN FULL B$F'OR$ PLAN REVIEW i�TILL BE STARTED
------------------------------------------ ------- ---------------------------
T� APPLICANT IS: (circle one) OWNER o CONTRACTOR
JOB SITE ADDRESS: �3S `v r 7'�,�-� l.�d� � ZIP:
(work)
N1�ME OF OWNER: �i // o �e �i �.�,�J PHONB: (home) L/7/-�S��cS
MAILING ADDR$SS: CITY: ZIP:
CONTRACTOR: o ��o ma � � oY'S' N PHONE: L-/77` - 9/�y
MAILING ADDRESS: �' S o � CITY: �ov�cl ZIP: �3(0�
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
scribe in detail : � 4 0�
PROPOSED WORR (de ) .Q c9 � �
STORIES: SQ. FEET OF EACH FI.00R:
NO. OF BBDROOMS: GARAGS STALLS: ATT. DET.
$STIMAT$D CONSTRIICTION VALIIATION (eacludinq land) : $ O'� �
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: �-/�- 9/
lPlease fill out the reverse side of this form)
.. - ,.
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C ITY of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offic�s
•
� _ � � On the North Shore of Lake Minnetonka
D�1Tj! ���AC�.ADV��RY ,
In accordance with M.S. 15.165, "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 confidentia3 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 local , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or I.icense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permit.
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First Middle Last
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Phone
I understand my rights as stated above.
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BUILI3ING&ZONING—473-7357 � ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359
ASSESSING