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Mar 01 2010 9: 21RM TOP NOTCH HUILDERS 9524310575 p. l <br /> i�i7•Di- 0 �8:2Dam Fro�-CITY OF ORONO +B51Z4A4616 T-1Z3 P.001/ODZ F-T�5 <br /> Z �!9 t4� <br /> ��1 �d Z <br /> � �, � 1'� <br /> �It � <br /> y of arono <br /> Eiuilding Permit Application <br /> far N�w Structures ar Additian� <br /> Maili'0 Box 66. Permil nurnber: /l��l>�%/ <br /> ����� Crystal Bay, MN 55323-Oa66 Data rec��ived: .3 O/ /d <br /> r <br /> � ;�' � St�eetAddress:' Receiveoby: <br /> e� �� 2750 Kell�y Parkway Plan revi�:wfee: <br /> ��sHo�' Orono, MN 55356 <br /> Total F�c� ,� //„/���� <br /> Main: 952-249-q$00 Fax: 952.249-46t6 www.ci,orono.mn.us �/ ! 't�-(� <br /> This applicati�n form must be completed in full and all required information rr�ust be submitted. <br /> Incomplete applications will be returned, (Plesse pr,nt) <br /> GEN�RA� INFORMATION; <br /> Job Site Address: � 1 (> � ��a� /�� ��� �„t� <br /> Will this be a Parade of Homes, Remodelers Shcwcase Home or other Display ome? ❑Yes No <br /> 1/yes,a spociel B�enr permif is requirod wilh ooliCe DepaRn�onf and City Cvunci!epproval fi0 days p11o�t0 the evan� ShuN� Gus service wAi be <br /> �quved uniess applican�Gemonsn�tes SuH'�cient on.sire parkinp r's availab�o, Npn-parmitted evenis wil/�ol De alrowea. <br /> CONTRACTOR 1 APPLICAN7 INF�RMAT101V; <br /> Name; _ To � �V o�� �t//LrD�S <br /> State License# y Z g �� Expiration I,�ate' o v <br /> Phone� - � 7 affice -�-zs4 (ceu) <br /> Mailing Address: r Cit ; 4,?/r Z�p; g-S3n6 <br /> Contact Person: A � S T Applicant is: on[racco / Hornaowner �c,�����1e� <br /> Finail and�or Fax� rn t.r-s . ,�„ _ � ,��! <br /> � <br /> PROPERTY OWNEf2 INFQRMATION; <br /> Nam�: P.i�k �Q,o 5 S�ert c.r2 <br /> Phone(day); � <br /> Address; Zl�S Sv�'o,r�oc� �� City (�iQ,d�{/J ZIP: SS,�s"6 <br /> Email and/or Fax -- <br /> ARCHIT�CT/ ENGINEER fNFORMATI�N; <br /> Name: <br /> Phone(day): •- <br /> Address: _ _ ���y. z�P: <br /> Email andlor Fax: � <br /> PR�.I�CT INFORMATION: <br /> 1.7ypa oP PrejecC 2. Proposed Use 7, Struewre Type 4.Sew�go Risposal & <br /> Wate�Supply <br /> �New Construction Q,�Single Family with ❑ ReSide�ce <br /> ❑Addirion attached garege Q Gerage!Accessory 13idg. � Public Sewer <br /> ❑Aceessory Building [,) Singie Family with � Deck <br /> ❑ Relot�alion deeaehed garage [� Otfice/Commercial i <br /> ❑ Other (speciry) ❑ Multipie Famiiy/Co�do ❑Werehouse C Private Sewer <br /> ❑Public Storage �'.Public Water <br /> "'Any eerth movoment may r�quire ❑Commercial �Other(speclfy) <br /> MCWp�eview 8 permits. ❑Industrial ❑ Pr�va�e Wen <br /> Minnehaha Creak Watershear Distric�(MCWB) []Othe�: (specity) — <br /> 18203 Mlnnetonks Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�471�0590 <br /> Fax; Bfi2�{71-0682 <br /> un,vw,m1 n a r. k.or <br /> Estimated Construction Valuation (exc�uding land) � �jp� �_ �� <br /> LBSt UptldlCtl: 9/29/20D9 � <br /> Co•�j'J�enN� /�C-7�•l� cST�}/LTEd �y D i�Tf�ls�t.. C,o nl Tl�+4'�-7z'R �t�.r ��`j- o o G C1� <br /> � ( n,,,._ . � �e� <br /> �l N R L /N'S�I OA/Lu N� �Ge� /'����- V•K-' � . <br /> 7 <br />