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<br /> City of Orono
<br /> Building Permit Application
<br /> for New Structures or Addition
<br /> Meitiory Atieiregs.
<br /> Pe onitita
<br /> A ' PO Fk
<br /> Ek)) 66
<br /> 0 Crystal Hay, MN 55323-0066 LY 3 rmuiyed:
<br /> 1 '
<br /> Streetil Adifire.w; 1 -occiYed by: 144,C
<br /> +,
<br /> .4 . 2,50 Kelloy Parkway
<br /> 1;4, . r 4./ • Ptan if!VA4fhit F4M) C261/45.—P/ '9
<br /> Orono, MN 553513 di /
<br /> -II# sHo*>*-/ Main: 952-249 460(1 Tc.4a,1 Pe - 471-(.0 5
<br /> Thie Implement'km Met be CetereZeteed ie tilt end se - • 'tkirnebeh must be submitted.
<br /> kegetepietele00114Mene me be .1 - (Reese pont)
<br /> GENERAL INFORMATION;
<br /> Job Site Address: "Z71!It ., ,.bt,i ") -t Ka.. , . oil.ke 5.$3 3 I ,
<br /> Will this be a Parade of Homes, Renlodkriers ShowoaS.Atv le or other Display Home? IA Yes br:1 No
<br /> ..„.
<br /> Oyes.
<br /> &spode(event porTrut i5"squired 4i*:2%kr*ilvalnwg 4riti Cxty str ;1 ariCutA,Lik'6t thdYN PlOf In rtK 6vi'l1 SM-11)*bo-r N"1411: #w t*
<br /> reGurgra oirliesS 8,0061:70.1f dernonsliatycl 9.0/,,..Aryvt on stir,par0rALL9 LS a ~ v wo pern741011.4-witorIts.WO'nol tle-,Mowed
<br /> i N
<br /> CONTRACTOR/APPLICAtfT INFORMATION: N
<br /> Name' 3"—Trm
<br /> State License ti r,' i6 1
<br /> Mona. cell)(Atz .A.)."....._.%, ill, , (office) t
<br /> Malting Address: -,41..4,,_____1_11.1 1.,„),0,r rii ,.‘y Avu/1. ,)d,
<br /> p
<br /> Contact Persocr __„, ity-de , -- plicant Ti,eoth,c_
<br /> Email Ond/Or F ax: ,‘V. . .
<br /> PROPERTY OWNER INFORMATION:
<br /> Name. Ctaii"E PriL4Z.el 1> ____ .
<br /> Phone(day), C.I? ‘1,1P 745C...___
<br /> Address: 27 LID h,,t‘',i,,,,s.,. \,!_____ItZ ... ... ,- 1
<br /> Email and/or Fax
<br /> ARCHITECT i ENG*152ER INF NI • ON: -/ilkalii\icr
<br /> Name ii,'1.
<br /> Phone(day). - ?,../ •
<br /> Address. . 1.010, 1:\-- , 1,-,. is' ) ,...„4,, it Z4 I _ (
<br /> Email andlor Fax eh"-4- b , h 44- t ta,.,,,11..,,iw,„,,,,. .,4,..-4-0,.. ,
<br /> PROJECT INFORMATIO Description of protect
<br /> [
<br /> M AdNew Construction
<br /> ciition
<br /> n Al)13.1..csoly Building 7 Proposed Use -- - i.'S-ir=
<br /> 1.Type of Project ciu -i(..0 -1/(40
<br /> U Singte Family with
<br /> attediriti garage
<br /> El, Sin gtri I';witty Alit, M Accessory tting .'Garaw, ViAti" Supply
<br /> U neck
<br /> fl Offir.e.,'Commercial El Public Sewer
<br /> ;
<br /> 0 Reim:Vain detached garage: 11 FA'esuti awe ! 1 1 Priviitu Sewer
<br /> Li Other(speoty) Li Muthple t amity:()Laid() 0 Ret.ainirig Wait(
<br /> 0 Public 4-feet or greater 0 Public Vihiter
<br /> Any earth • . - may require 0 Commeroal U Storage
<br /> MCWD review&permits. 0 Inchigtrtof nm„„hr.,,,,.. LI Pb We0
<br /> 1
<br /> Minnehana Crook 1/11alerehtx1 Damao(h&CW0,1It Other(specity) FI Other Ospireatyi
<br /> 15320 Ilinnelonlia Blvd
<br /> for4 Ilak,•-ir
<br /> Minnetonka.MN 65345 ,
<br /> Phone 952-4714590
<br /> Fax 17012-471-0682
<br /> $ 5-0 000
<br /> Estimated Construction Valuation 4uxciuding land)
<br /> } _
<br /> Vzocice!i
<br /> 1L t ipaelfttif Akaw..4 201-5
<br /> r
<br /> Paw 21
<br /> %.-...,......
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