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City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) -� / <br /> Mailing Address: Permit number: �t� Q —0071 <br /> "I-41 <br /> \ Cr Bax 66 <br /> - \\ Crystal Bay, MN 55323-0066 Date received: /0A9/62 9 <br /> a '",' L ti Street Address: <br /> Received by: fd <br /> 1,F, 1 ,, 1`'f. o~ 2750 Kelley Parkway Plan review fee: <br /> lN ►•41i�1 <br /> gE$HOg�' Orono, MN 55356 <br /> Total Fee: /5"D i 75 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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 INFORMATIO <br /> Job Site Address: J� Z% /J//he/ ,//i AV <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/APPLICANT INFORMATION: <br /> Name: S L( Q <br /> State License# %CS C) Expiration Date: 3,,,/4.A6-) <br /> Phone: O' <br /> / � ,f J _ ;77....i).. .- (office) (cell) <br /> Mailing Address: WI' /,ti(r't J,-'(' Ai <br />