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� � ---__ . <br /> � � <br /> 1��'" i/' <br /> City of Orono - <br /> Building Permit Application <br /> � �l � for New Structures or Additions ��. �gg <br /> ::-- Mailing Address: Permit number: d���! �7U <br /> _,�., <br /> j:�,0,jv.`�\ PO Box 66 <br /> '� � Crystal Bay, MN 55323-0066 Date received: 7—�J���— <br /> �;'O .il.. O� <br /> !�I� ��-='"� � Received by: <br /> �,� r �,�; Street Address:' <br /> �'S',�, ;��� xt� �ti�' 2750 Kelley Parkway Plan review fee: ,S• <br /> �qk��og,�% Orono, MN 55356 a� /a—�� �/ <br /> �_, <br /> `=_ -� Total Fee: <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 INFORMATION: <br /> Job Site Address: 2755 Ca.Sen �o�.•rr �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [� No <br /> H yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: kv1.t �1 e.Si.g•., �v�� <br /> State License# 2p3�n� (D� Expiration Date: 3 - 3 - I 3 <br /> Phone: 95 Z� 935 - ��-14q (office) (ce��) <br /> Mailing Address: � , 5'� Cit : �o k'a S ZIP: 553y3 <br /> Contact Person: AN ('nvR � Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: '�a,N � �c�I,�l �S;•w v��� . CoM <br /> PROPERTY OWNER INFORMATION: <br /> Name: M,Ke � S�.o.co.� �as l�C i e.l.c�, <br /> Phone(day): 5 2 - y-�� .,2y 2� <br /> Address: �( Z�55 Ca5 co 'P�'�wt � city: O roN� ziP: 5539 / <br /> Email and/or Fax M basK�:eld. A B�-skC:e1 , cor� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction �Single Family with ❑ Residence <br /> I—I Additinn �+tached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ngle Family with �Deck <br /> re, � �tached garage Office/Commercial ❑Private Sewer <br /> �aN ��v T� \{ Itiple Family/Condo ❑Warehouse <br /> y blic ❑Storage ❑ Public Water <br /> 1 mmercial ❑Other(specify) <br /> ustrial ❑ Private Well <br /> � ier.(specify) <br /> �j��`���'"� �1 �'� � <br /> �r- <br /> �r <br /> �d� � ��`i�."��, <br /> �o�., �C.�•�. /� ;� <br /> �1 �- �-1� 0 --0� 33 <br />