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/ , O_K-4S7//c=3} __ <br /> it .33 fit <br /> City of Orono X7(o <br /> Building Permit Application L- 6A-• tit <br /> > \-\) <br /> for New Structures or Additions 1 0 <br /> Mailing Address: itpebI3 O/©[ <br /> /g,O �. PO Box 66 <br /> Permit-number: <br /> Crystal Bay, MN 55323-0066 Date •received. A <br /> a �� .� a,,, Street Address:' Receivedby: <br /> \\ <br /> tel '� 'l oti`�/ 2750 Kelley Parkway Plah7eviewfee: <br /> 9 Orono, MN 55356 <br /> \kEH�g y <br /> Total Fee i <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us "�i Kttc�d�i .-1 �i <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: +04`5 L)ArE 0 WO, f oAQ OPersto Am-1, ss3S1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display/Home? _ Yes .No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ' D/\tUA- KE11-E1 1 �/ <br /> Phone (day): G (PI 7 7.3 T-' $Q3 <br /> Address: - y a In.) tM--.1 .L,,y14 7 Cit : Q'' 94o ZIP: 5535 <br /> Email and/or Fax 9r'QQ1 ct 10..v..f);"co,- * S;r-t A , CO <br /> Name 9\alPhonEY I V CV1V <br /> Addre City: ZIP: <br /> Email LAN MI5 <br /> PRO. <br /> LA <br /> ( ,�) <br /> 1- Typ ��� ,' Ise 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> N-Ne\ n r ily with E Residence <br /> �(,(Adc 4 V \ tl ur arage •EaGarag e/Accessory Bldg. ❑ Public Sewer <br /> Acc iily with ❑ Deck <br /> W <br /> RRel <br /> ((�-C L Garage ❑ Office/Commercial ❑ Private Sewer <br /> hilly/Condo E Warehouse <br /> **Any / ❑ Storage ❑ Public Water <br /> V.Q.�/�i c LD I CI Other(specify) <br /> MCW[ 1 I <br /> Minneh ❑ Private Well <br /> 18202 I �IfY) <br /> DeephE <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.ora <br /> Estimated Construction Valuation (excluding land) $ ; COO - <br />