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Oct 10 2006 9: z9RM HP LRSERJET FRX 612-825-1900 p. 3 <br /> � � i^ � �_� ct <br /> ��L� <br /> � �, � i , � � G� <br /> Total Fee: S D 3 � Date Received: ; ': - ! r.� f.'�, <br /> Entered By: . Permit#: _� � ,�,, <br /> CITY OF OR NO - BUILDING P�RMIT APPLICATION <br /> All information mus be submitted in full before plan review will be started. <br /> (please print al!information) <br /> THE APPLICANT I5: circ[e one) OWNER O CONTRACTOR <br /> JOB SITE ADDRESS: � O C V IA L° ZIP: J.���1 <br /> Will this be a Parade of Ho es,Remodelers Showcaae Home or other Display Home? <br /> ❑ Yes ❑ NO Ifyes,asp cial event permit is required with Police Departmeni and City Council approva! <br /> 60 days pri r to the event. Shuttle bus service will be required unless applicant demonstrates <br /> su�cient -site parking is wailable. Non permitted events will not be allowed <br /> NAMEUFOWNER: ^ 1'Q I'►C'%!� 0 PHONE: (home) 1�v�2:B�$-38ZS <br /> (work) <br /> MAILING ADDRESS: 3 D Ve- CITY: 0� Zc�.'�GL ZIP: 53� <br /> CONTRACTOR: 01'�{`I u oo �l �m oL�� 1 i r� PHONE: (vl7-SZS -335,3 <br /> CONTACT PERSON: �e � M BILE/P GER: <br /> MAILING ADDRESS: �"Co �. CITY: in I ' ZIP; Ss�f19 <br /> STATELICENSE: # 2. q EXPIRATI4NDATE. 3/31�0'j <br /> ARCHITECT/ENGINEER: pHONE; <br /> MAILING ADDRESS: CITY: ZIP: <br /> NAME: REGISTRATION: # <br /> TYPE OF WORK: New H me Addition Accessory Structure <br /> Move me Remodel/Alteration (ie: Sid.ing, Windows) �� <br /> Any e rth movement may require MCWD review and ermits! <br /> PROP05ED WORK(descri in detain: �IY�o v� Qv1Q ep �C P d 0 <br /> n us �e ra � <br /> STORIE5: .FEET OF EACH FLOOR: <br /> NO. OF BEDROOMS: GARAGE STALL5: ATTACHED DETACHED <br /> ESTIMATED CONSTRUC ION VALUATION(excluding land): S_ �5�,UO O <br /> I hereby apply for a building pe it and I acknowledge that the inforrnation above is complete and accurate; <br /> that the work wiU be in conform ce with the ordinances and codes of the City and with che State Suilding <br /> Code;that I understa.nd this is not permit a.nd�vork is not to start without a permit;and that the work will be <br /> in accordance with the approved lan. <br /> APPLICANT'S SIGNATU : � DATE: �� I �/ <br /> 31 <br />