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�,;r/�� /�y <br /> �. h `� �`G� ��- <br /> � Total Fee: $ DateRe�eived: 11�� -"� � � � <br /> Entered By: �'�=1 � i r,�. (-l t%/ ��i j Permit#: -1� � C�'3i�� <br /> CITY �F ORONO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan reyiew will be started. <br /> (please prtnr all injor»u�tion) <br /> THE APPLICANT IS: (circle one) OWI�TER OR CONTRACTOR <br /> JOB SITE ADDRESS: �1�p O - _ _ � �D ZIP: <br /> Will ttus be a Parade �f Homes, Remodelers Showcase Home or other Display Home? <br /> ❑ Yes ❑ NO If yes, a specia/event permit is requlred with Police.�lepartment and City Council appraval <br /> 6D days prior to the event. Shuttle bus service will be required unless applicant demonstrates <br /> su�cieni on-site parking rs avnilable. Non permitted events wil!not be allowed <br /> NAME OF OWNEit: �-efi��-�� �USr�Y�, PHONE: (horne o�' - tpw�p <br /> (work) <br /> MAILING ADDRESS: � CITY: ZIP: <br /> CONTRACTOR: Renewal By Andersen pHONE: <br /> CONTACT PERSON: 1920 County Road "C" W est -AGER: <br /> MAtLING ADDRESS• Roseville, MN 55113 Z�. <br /> ' — License #20130983 <br /> STATE LICENSE; # 651-264-4777 DATE: <br /> ARCHITECT/ENGINEER: PHONE: <br /> MAILING ADDRESS: CTTY: ZIP: <br /> 1tiAME: REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Structure <br /> Move Home Remodel/Alteration (ie: Siding, Windows) <br /> Any earth movement may require MCWD review and permits! <br /> PROPOSED WORK(descrlbe in detai�: �p,��_QSQ a�- l�l11�U��S �,t>/i��, <br /> _� � , <br /> STORIES: SQ.FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALL5: ATTACHED DETACHED_ <br /> Cl� <br /> E5TIMATED CUNSTRUCTION VALUATION(excluding land): $ � <br /> I hereby apply for a building permit and i acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with the State Building <br /> Code;that[understand this is not a permit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> APPLICANT'S SIGNATURE: DATE: ��f`Q� <br /> 3] <br /> b 'd 06T9�G9iS9 3�IA213S 1IW�13d Q '8 S �I 9T ��T 600Z 8T ��C <br />