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' City of Orono
<br /> �uilding Permit Application
<br /> ft�� Nevw �tructures or Additions
<br /> �� Mailing Addr�ss: , .
<br /> Permit number: G � - C/t t.:t�
<br /> �/ ���� ���BaXBay, MN 553 -0066 9 Date received: ID- �-)7
<br /> ��y,'�� St�eerAdd�e�s:' � 00� Received by:
<br /> `�. y� ,� ��"� -.-;:0;:�I.ey Parkway �� Plan review fee:
<br /> ���1 ;,` urona fvi� 55356 ���3. � -
<br /> (941SH�)��-' ` MGin 952-249-4600 �O 1 o t 39 ��
<br /> \`-�.f Fax: 957_-2_49-4616 �.�;��,��,.-rr��s Total Fee: �O 1 "7 —O /�-,�O !
<br /> ':P is���lic�iion form must be completed in full and all required information must be submitted.
<br /> Incorzt�!Ete ac;alications will be returned. (Please print)
<br /> GENER� _. .::���-�� rt:y��:�:
<br /> Job Site A��_:::rt?s�,� Z,6 70 (n�,r�., rL �r<uz.
<br /> Will this b� ?�ru:�_ �r -omes, Remode;e;s Showcase Home or other Display Home? ❑ Yes No
<br /> If yes,a speci�, a�c pe r„�-�s�:�iuuPa wir.r�Police�eoar.ment and City Council approval 60 days prior to the event. Shuttle bus service will be
<br /> required unless a_:oi:can:a�monsrrates sutfi�ienr on-sire parKing is available. Non-permitted events will not be allowed.
<br /> CONTRA : _ . _ `" i:i.fORlili�:1 iJf�:
<br /> Name: �+ ��.c�..s ��c���:o., c�.��
<br /> State Licer=- l�_3_��____ _________ Expiration Date: 3 3� Z o �
<br /> Phone: --'--� I Z-_3 8 6 -�3 3 S (office) c�7S-Z- �l N J — � �,
<br /> Mailing Ac�:.- �����7� .L_ _ Cit : z�P: S`S 3 7 9
<br /> Contact Pe. �'�.;}-Z _ ��_ Applicant is: ontractor / Homeowner (Circle One)
<br /> Email ana�or �, _��m���� 6 �n��c.� - C.��
<br /> PROPEi��,� _ , . -�.,��.
<br /> - .. _..�,v.�_...,...
<br /> Name: ���,.� _ �- � _ �-�,�r S�-��4h�
<br /> Phone(day; _�j Z_-�qS�Z3
<br /> Address: �'7� Ho.�i•���r, Clty. D��M J ZIP: rS3� r
<br /> Email and/o �tc,i�1�;��.i�r�,c,,•,_ Lzw.
<br /> ARCHITEC' -;��r�,�'^,�=c� s�riaR�Ui,4TION:
<br /> Name:
<br /> Phone (dc��
<br /> Address: City: ZIP:
<br /> Email ana/c: w,,.
<br /> PROJECT =�'?� `�`��` � w ��es�ription of proiect:
<br /> --- - --- -
<br /> 1.Type of^� : _ �. �rcaosed Use 3.Structure Type 4.Sewage Disposal&
<br /> � Water Supply
<br /> ❑ New Cor.:.� : . ��rgle Family with ❑Accessory Bldg./Garage
<br /> ❑Addition � `attached garage ❑ Deck ❑ Public Sewer
<br /> ❑Accesscr � ❑ Single Family with ❑ Office/Commercial
<br /> ❑ Reloca�lc,r ' �e*-ached garage Residence �Private Sewer
<br /> �Other !::_- QMp_ [.� � 'Jluitiple Family/Condo �Retaining Wall(s)
<br /> ����� (�;��wS ^� Public 4-feet or greater ❑ Public Water
<br /> ""Any earth -� - _ . , .�c;uir� � Commercial ❑ Storage
<br /> MCWD rev� �: �"i Industrial ❑Warehouse [�rivate Well
<br /> Minnehaha c n�ztF � �:r,c�;Mc���1�; ^ Othec (specify) ❑ Other(specify)
<br /> 15320 Minne�� _ _ ..
<br /> Minnetonka,i i.! ,-.. — -�
<br /> Phone: 952 -. .
<br /> Fax: 952-47':-L�, '
<br /> unvw.m�rtnehahaqeek_or�U
<br /> Estimatec : ..: :,-. ,,�;:clud �,� !a,-,d� $ Z Z.S�Ou.�
<br /> UC� ��
<br /> Packer�<: : :; OF ORONO
<br /> Page 21 C+�TM
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