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� 0��,26/2009 10: 09 6126994982 DAVID SCN� P�GE 01103
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<br /> � Ci of Orar�t�
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<br /> Building Perrnit Applicatian
<br /> far New Structures or A�ditivn � � �9� 7 -� �.
<br /> Maning AdCr�ss: ,7 � , � �.
<br /> '��,� P4 Box 68 Perrt��t nur►iber � �:.� `� �%� � �
<br /> a ❑ Crysta!Bsy,MN 55323-0066 ��ie�;N�a Z� :D�:��.
<br /> a a Stl�efAdd�sss_' Recerved'by: �
<br /> �� � � 2750 KmIIQy Pa�kWey Plan rev,ew fee �+t �� � .
<br /> �a¢� Orono,MN 55856 ?,�,
<br /> — 7ota1 Fee�� �? ��
<br /> Main_ 9a2-249-4800 Fax: 852-249-4$'16 www_cf_or4no.trK�,Us
<br /> 'fhis application form must be completed in full and alI required in#om�ation must be submitted_
<br /> Ir�complete applications will be returned. (Please p�nt)
<br /> , C9EIVERAL ENFpRMATIQN;
<br /> Job Site Address: �� � �}���tiJ�,�--��� �'�
<br /> Wili this be a Parade of Homes, Remodelers Showcase orne or other Display Homa7—Q ves LJ I�o '��
<br /> !t yes,e specxa/vv�nt pem,r�/s�quired with Po1�c�Deperb»ent and Gty Council�pproval b'0 daya prlor to the event ShuCla bus s2rolae ewA be
<br /> requlred unless Bpplicarrt demonstrytes suftrclerrt on,�rlte parklnp Is avaflabie. Non�aerm![ted event�wrl/not be eflowed.
<br /> CONTRA.CTQI�1 APP�ICAI�lT INFORM/�7'ION:
<br /> Name: � . � `��
<br /> State License# 2 0� S 3 8 I F�cpl�tion Dafe: �__��•�o► o
<br /> Phonc: � a�Gg �j
<br /> Mailing Address: G,.. r Ci • � ZlP; /
<br /> Contact F'erson: .r..�' G i. � ~�� Applicant is: n#racto Homeawner (CirtJa Pno)
<br /> �mz�il z�nd/or Fax: ��,�,, �j �/,,..� /.� __ C�S .C'►'a � ,
<br /> RRO�ERTY DWNER 1 QRMATION: {� � � �
<br /> Name: �GL�,h� 1 V 49".i�l��\)1�
<br /> Phone{day): _,�;�-�+��--�-�- CS r
<br /> Address: ���1'7- �,,.y�,r 1���P_.M�p__ ���f�Y. ZIP: _���''1
<br /> kmaii and/or Fax 1.f�lt��kU� �3„��,�-�,��[)2��J.} P�A?G� Co M --
<br /> ARCHITEGT 1�NGINEER IN�pRMA'�'tON:
<br /> {Varne= �h��- � hn
<br /> Phone(day): _ _ � k �, ��y,
<br /> Address: p x 1C�Z Cit r�,_ti„ ��.-. ��P• � �
<br /> �mail and/or Fax: �.V'�C�s�2C]N1 �, �40�._-_Cd�� __
<br /> PROJECT II+IFORMATlON:
<br /> 1.Type of PfGJec! 2.Prepoacd Use 3.3truC#ure Type a.Sewage Dtspasal&
<br /> Water Suppfy
<br /> eW COf1stTUCtldn 4inplr�Familywfth ' Residence
<br /> ❑Addition attachad garage rerge/Accessory 8ldg. �ublle Sewer
<br /> ❑Accessory�aild'ing ❑ Single Famiry wrth D�ck
<br /> ❑Rclocatfon detached garage oific�/Commeraial ❑Pr7vate Sewer
<br /> ❑Other.(speafy) ❑Multlpfe Famify!Condo e Wareh4u&e
<br /> ❑Pubfic ❑5torage �Public Water �
<br /> **Any eat#h rniavement may require �Commercial ❑Other(spacify)
<br /> MOwD review�perr.�its. []Intlusuial ___ ❑Prlvate Well
<br /> MtnneE�shs Cregk Ws�tersh�:�c1 Dlstrict(MCWD) ❑pther:(specify)
<br /> 18202 Mlnnetonka Blvd
<br /> bEephavpn,MN 5539�
<br /> rnpng: 952-4T1-059U
<br /> Fex: 952�171-0682
<br /> .minrtehahacroek.o
<br /> Estimatsd Conatr�Ction'Jaluation{excluding fand) $ �� ' —
<br /> �st Updatad: 5/21l20D9
<br /> -2a-
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