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444 <br /> City of Orono r, <br /> Building Permit Applicatio 1 <br /> for New Structures or Addition <br /> Uslgrip Addnec Penta n~. .?O/ DO <br /> Poll s6 <br /> �oN� CrysU1 say.MN 55323-0088 Date)ealNd: <br /> .� <br /> Sinner Address: Rac9Nsd by:. -. <br /> 2750 Kelley ParkwaY Plan revIsa,fee: 1 I .Ora <br /> 'i Orono,MN 55356 <br /> •t eNOa Main:952-25&4800 TobiI— <br /> Fax:962-249-x81fi Ix p <br /> This appike8on fpm must be calnpleUd in full and all required nlomiatlon must be submitted.Y(D i•3S c C <br /> In. late applications wRl be retume&(Please print) <br /> GENERALINFORMATION: /L'I� �DA� Pi �V <br /> Jab Site Address: 2 CJ <br /> Will this be a Parade IN Homes,Remodalon Showcase Home orwo��yDt ay�Ho shaft—Yes—wrxha o <br /> ayes.sapzrN anrx Wnaxa rNuae wNtfbaw aapwallNx anday COivx']aPWe aroMslar nM Ma9awad. -n <br /> ,axu,ee w...wPM<.+ W,nwu r.m•w.wra^ar...z.N..Nan-Permmen " py <br /> CONTRACTOR I APPLICANT INFORMATION: �f <br /> Name: �'tj O G //SiPana., �oR._5 $goo° <br /> zg1 5O Expsasan Wls. ZQI <br /> State License# olfiu <br /> Phone: ixaB - _ CItY ln� ZIP: 3�g17Z <br /> Mailing Address: -' �-�^ _i•� Ho111apwner few.onal <br /> Contact Person: �'2'oH AA Applkxn b:�a0x#9W <br /> Email arx#m Fax: <br /> PROPERTY OWNER INFORMA I L <br /> Name: ra <br /> Phone(day): !o t2�Ga y)� CMY Int �-ILa ZIP'SS34S <br /> Address: <br /> Email and/or Fax •.l <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): Cgy ZIP: <br /> Address: <br /> Email andlor Fax: <br /> L = Ux <br /> PROJECT INFORMATION:Desai a oPf L sbuclun Type sang.Disposal s <br /> 1.Type of Project Water supply <br /> ❑N.w Cone c5on ❑Singb Family wxh ❑Rnitlanu Pubic Sewer <br /> ❑AddRm aHaehad Bang. Gan9e I Aaaaeaarysles. ❑ <br /> cosawy,Buidkq ❑Sin9b Family vnth Deck <br /> A <br /> Qd.beh.d garage DllicdGommerdal ❑Private Savmr <br /> LJ uNl ❑Multlde Family I Condo Warehouse ❑Pubkc We- <br /> 1,11c Ot <br /> -Any <br /> e- <br /> -Any nrlh movement may Paquin ❑Carnmemlel ❑ r(specify) <br /> ❑ ❑PdvaU Wall <br /> na P.-,.. Industrial. w WNarxhwd <br /> pialncl(MGwO) ❑Otlian(epadly) <br /> 18202 Mk naldae Wil <br /> oeaphevan,MN 56391 <br /> Prime:952ZI-W90 <br /> Fu:9624714*U <br /> Estimated Conseuclum Valuation(exduding land) S�0 0 <br /> Pecker Lest UP"W­W01" Paw22af23 <br />