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City of Orono vN.1 <br /> . ti <br /> Sign Permit Application <br /> Street Address: Permit# c2GIAa•-•e/AOY <br /> 0�0 2750 Kelley Parkway Date Received: ///to// <br /> -:,,, '4y \ Orono, MN 55356 Total Fee: I/ c�, <br /> Staff: "6 . G.N• . m G <br /> ` ..- Main: 952-249-4600 Comments: <br /> vs, fax: 952-249-4616 <br /> .. , iia,,,i,' has Mailing Address: <br /> irzslio4� P.O. Box 66 <br /> Crystal Bay, MN 55323-0066 <br /> This application form must be completed in full and all required information must be submitted. Incomplete applications <br /> will be returned. (Please print) <br /> GENERAL INFORMATION: .2 ,, RI / <br /> Site Address: (r��`� <br /> CONTRACTOR/APPLICANT INFORMATION: J� �n <br /> Name: t. ..-I (L L'/SAil 0 r <br /> State License# r, Expiration Date: <br /> Phone (Office): c• , nk Phone (Cell): <br /> Mailing Address: T,,,,, ,K ��`�Email: Fax: <br /> Contact Person Applicant is: Contractor Homeowner <br /> (circle one) <br /> PROPERTY OWNER INFORMATION: I i � •C+-1-ei <br /> - -1 11 e--)TS <br /> Name: <br /> Phone (horn- : :-) i1 ,r` 'fi L 4 0 $ Phone (work):' C 1 isa <br /> Address: — . WR . <br /> Email: • ) L C" ' lig S , Fax: . <br /> CUM , • <br /> PROJECT I `FORMATION: <br /> 1.Work Intended 2.Proposed Sign#1 3. Proposed Sign#1 4.Signs to be Removed: <br /> []Sign Installation Sign Face Length: 141' /5: Sign Face Length: Number of Signs: 1 <br /> [],Temporary Sign(flat fee) Sign Face Width: (;,I LI'7 Sign Face Width: c//, I ,, <br /> 4 Sign Alternation/ Total Square Footage: Total Square Footage: Square Footage: cS K-fl&- -• <br /> mace Change Top of Sign to Grade: Top of Sign to Grade: <br /> Distance from bottom of Sign to Distance from bottom of Sign to <br /> Grade: Grade: <br /> Materials: Materials: <br /> J]Wood []Wood <br /> -- lastic []Plastic <br /> j]Metal []Metal <br /> [I Other []Other <br /> [IN/A [] N/A <br /> Illumination: Illumination: <br /> [] External [I External <br /> Internal [] Internal <br /> '[]`Indirect [] Indirect <br /> []Other IBJ(, C tane. []Other <br /> [] N/A [] N/A <br /> PLEASE NOTE: A Minnesota State Electrical Permit is requiredrif electrical work is proposed. <br /> Estimated Cost: (All work is to be done per UBC) $ 1�J'Tc.Q b ir * Minimum permit fee = $35.00 <br />