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. CITY OP OR02i0 - BIIILDING PER.'�iIT APPLIC�iTION <br />^ct�. <br /> 1 ree: $ ��C � �G' Date P,eceived: � /�' " I <br /> ' Date P_DD=OVeG� : <br />:ntered By: " �'� _ - - <br /> Pe_�it�:���/ <br />',.�.I, INFOFZMATION MIIST BB SIIBMIT'�SD IN F�D�L BEFORE PI�AN RE�7IEW WZIS• B$ STAR�� <br /> (See Check-off List BncZosed) <br />_ --------------------------------------------- <br /> :�.; AppLICANT IS: (circle one) OWDIER or CONTRACTOR <br /> ,� SI� ADDxBss: 1305 Shoreline Drive , Orono ZIP=����� <br /> (work) 546-9707 <br /> �.�: pF owr7�z: Mr and Mrs Wi 1 1 i am Po�p PHorrE: (home) 476- 1061 <br /> AILING ADDR.ESS: � �n5 Sho1^P1 i nP �ri vP C=�=_flrnnn ZIP' SS��� <br /> �NZ'RACTOH:,_M�,�^n n N i i rl c n n 11 a t h N I I,Il„$���N�T R I I('T T(l AI PH��=�.Q,L�.a�..�?� <br />_-:.ILING ADDxEss_10220 38th Court No . �_�= Plvmouth , MN ZIP= 55441 <br /> -�� I,ICENSE= � #0005194 <br /> :3STECT/�7GSNEER: NON ---- PHONE: <br /> wI,ING ADDRBSS: CITY: ZIP: <br /> ._.�: RSGISTRATION 4 <br /> ?E OF WORR: New Addition Accessory Struczure Move <br /> Demo R�*nodel/Alteration�_ Renovate Land Alteration <br /> 'POSED WORK (describe i.n detail) : IncrPasi ng rnnf �i trh nn sarri ana hniicac � <br /> six dormers <br /> ;?ZIBS: SQ. FEST OF EACS FLOOR: <br />' . OF BEDROOMS: G�GB ST�iI.I.S: ATT. DET. <br /> 'I�SSATED CONSTRUCTSON VALUATION (ezcluding land) = $ ,�, R�n ,�,n <br /> �reby apply for a building permit and I acknowledge that the iaformation <br /> ve is complete and accurate; that the work wi11 be in conformance with the <br /> ,inances and codes of the City and with the State BuiZding Code; that I <br /> :erstand this is not a permit and work is not to start without a Fermit; and <br /> ::t the work wi11 be in accordance with the approved plan. . <br /> DATE: � ^' <br /> 'LICI�NT'S SIGNATD�: � <br /> f <br />