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<br /> , ` City af Orono __ _
<br /> Building Permit Application � �
<br /> for New Structures or Additio ���� / J
<br /> MailingAddress: Pe�m;�,,,,m,e�: p?,8 �-o� a35
<br /> O�D,�.O PO Box 66
<br /> C�,.��a� Ba,,, MN 55323-0066 DeTe�e�a�..ed: /4"j 2" � �
<br /> ,a , �, StieetAddress:' Re�a�„ed by: S •
<br /> �'�, ' Gti`ti 2750 Ke��a,. Pa�kwe„ Re„ �e„�ew.es: ✓�� -�i(�C.e.
<br /> 1.9��Hog� O�o„o, MN 55356 c�D�l—' ?�
<br /> —- Tote� Fee.
<br /> Ma�.,: 952-249-4600 Fa.: 952-249-4616
<br /> This applicetion Porm must De completetl i� full antl all requiretl information ust be submitted
<br /> Incomplete applicatfons will be returned. (P/ease print � '
<br /> GENERAL INFORMATION: �-
<br /> Job Site Address: 1��]� �� i� -� S����C( � G� �ti�c� , �r���= , S�� �/ .
<br /> W��� th;5 be a Parade ofHomes, Remodelers ShoW�aSe Home o� other D�SP�a„ Home? ❑ Ye5 �0
<br /> If yss,a special event pem►it is required with Po/ice Qepartment and City Council approva/60 days prior to the evertt. Shuttle bus service w7!!be
<br /> required unless applkant demonstrates suflrcient on-site parking is availab/e. Non-pemritted events will not be allowed.
<br /> CONTRACTOR/APPLICANT IN�ORMATIO •
<br /> Name: S-}-��� �G�G�-e S
<br /> Steta �icense 'If Lxpirailon Date:
<br /> Phone. /Q�2 ����� �ofPice) ���L /Z� �Z� �cell)
<br /> /� t `
<br /> Mailing llddress. � p{1 Cicy: NY�PG ZIP: �� /
<br /> Contact Person. _�A��� �.��„til� Appticant is. l�ontractor I omaowner (Ci1�C16011�)
<br /> Emafl and�or Fax. . �� �' `
<br /> �C�r��'� i�Q C�e��_ �rZ�'v10�.1��� CS�^-_
<br /> PROPERTY OWNER INFORMA710N:
<br /> Neme: C' ..� d C�r � ' �c>�
<br /> Pho.,e (de„): � �
<br /> Address. 4 • C�t,,: ��/i� Pc-� � , ZIP: ss�/�7
<br /> Emeii end/o� Fex �'��✓t, L� � C_ �P,_�� .�c11-^�--
<br /> ARCHITECT/ENGINEER INFORMATION:
<br /> Ne m e: /�/!,,vt�l.� S�oc�
<br /> Pho�e (dey) (0(2 g7J — - c� .
<br /> Add�as5: 7 b�`? li��Y�. {'1�: Gt,,:lln�hv�-��,�ur� � ZIP: 5�5`���
<br /> Emeit antl�or 1 ax, i1f�l/lo�y�(�(�: Ca_jYl�/'•� l�Yl-�.
<br /> PROJECT INFORMATION:
<br /> 1.Type of Project 2.Proposed Use 3.Sbvcture Type 4.Sewage Disposal 8
<br /> Water Supply
<br /> ❑ New Co��«��t,o„ ❑5�„g�e Fam��,.w��n �Re�;de„�e
<br /> �"Add�t�o„ attached 9a�a9e Ga�age/A«e��o�„ Bldg. � P„b��� Sewe�
<br /> ❑A��esso�„ B„��d��9 ❑ S,,,9�e Fa m��„w�t„ ❑ Da�k
<br /> ❑ Ra�o�e�,o., defached garag/e� ❑0..��e/Comme��,a� �,P�;,,e�e Sewe�
<br /> �Qther. (specify) �Multiple Family�l�onOo �Warehouse
<br /> ❑ P„b��� ❑Sto�a9a ❑ P�b���Wate�
<br /> *'Anyearthmovementmayrequire ❑Comme��;a� ❑Ozne�(�Pe��.,.)
<br /> MCWD rev/�iew 8�pertnits. ❑ I.,d,.�z��a� (�P��„ate We��
<br /> Minnahaha lireak WeterSM1etl�istrici/MCWD , y
<br /> 1 � �ther. (s c'f )
<br /> 18202 M�.,.,a<o.,ka B�„e <ii i�C�e EtM���, CQ�r• J
<br /> DeeP�e.,e.,.MN 55391 '�'�—
<br /> Pho.,e: 952-471-0590 I�lb ������ � nS► �V�I
<br /> F e.. 952-471-0682 G-���
<br /> ehahacreek.or J
<br /> Est7m0ted Lronstruction Valuation �exclutling lantl) � �(� ���1�
<br /> Le��Uvaa�aa: 4/26/2011
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