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� �3� <br /> � <br /> � City af Orono <br /> ��- _ <br /> Building Permit Application � <br /> for New Structures or Additio ���� / <br /> Mailing Address: � I �o� a 35 <br /> 0�,�,�.0 PO Bo.66 Pe�m��e��mbe�. <br /> C�„��a� Be,,, MN 55323-0066 De�e � �e�,.ed. f O��2' J � <br /> a �, StreetAddress:' ReCe"'ed °'' 2�T • <br /> �',�, �ti�" 2750 Ka��e,. Pe�kweY P�e� �e..�ev,..ee: ✓,�1 "�i(�C.� <br /> �9,gE�o4�' O�o„o, MN 55356 c?O�l—' .�3 <br /> --- Tota� Fee: <br /> Ma�,,: 952-249-4600 Fax: 952-249-4616 <br /> Thls applicatio� form must be completed in full antl an required inTormation ust be submittetl <br /> Incomplete applications wlit be retumed. (Please print � <br /> GENERAL INFORMATION: ___- � <br /> JobSiteAddress: � �� �� i ,c� .�- s�G'.���C� � C���ti1c� , �r�.� ; S � �� <br /> W.�� th�5 be a Parade of Homes, Remodelers Showcase Hom e o� other D�sP�ey Home? ❑ Ye5 0 <br /> !f yes,a special everrt permit is required with PoliCe Department and City Council approva/60 days prior to the everrt. Shuttle bus service be <br /> required unless applicant demonstratatis sufficient on-site parking is availatrle. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INF�RMATIO • <br /> Nema: �-}-��� �C��es <br /> State License # Expiration �ate. <br /> Phone. � �2 ZS�Il�� �office� �Q�Z fZ�' ,�zlfJ �cell� <br /> Mailing Address. -1 �p n Clty. yl{'\�Gi � Z�P. �s A <br /> Contact Person. _��(��y\ ��(�y� Applicant is. l�ontractor � omeowner �C.�fC�B011Q) <br /> r p /� I' / ��yy��^, � C <br /> Email end�or rax. ��.Y\-t� • " ��.il.-`�`�('� -�� •IINI\���J�'� <br /> PROPERTY OWNER iNFORMA710N: <br /> N e�„a: s{�„'< �- _,� . ° ��€?� <br /> Pno„e �aey�- �G/7 �iy �q3 � � <br /> )� /� /� / /"��,� "`� /� �/ <br /> AdCress. Y�"C� FL�i('YYI(..�h //✓� S • 1 / City, �/tfl�✓2PG'loUl(� Z�P, �SYO(' <br /> EmaII and�or Fax r��rEj�r `. ��L�.P ��- L���.ti(�U�-^ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Ne..,a: M.,�infll�� Sjr�r.� <br /> PFione �tlay�� ��� ��� —�U� '1___ <br /> Add�aS�: Z ��`1 !r'I,�Yi� E'1�-� S� C�tY:�IL���r�-i����h� � ZIP: 'S�5`-/C!�S <br /> Email and�or f ax. p'yb"�/lC��{C�(�(�, (�'_ fL'iyl.� (�r��' <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Co„�«„«�o� ❑S��g�e Fem��y w�th R s�de„�e <br /> [�"Add,t,o„ p attached garage Ga�a9e/A«e��o�„ B�d9. ❑ P„b��� Sewe� <br /> �Accessory IJulltling ❑ Sfngle Family wlih ❑ Deck <br /> ❑ Ra�o�at�o., defached 9a�ege ❑0�.��e/Comme��.e� �,P��..ete Sewe� <br /> ❑Otha�: (�pe��.y) ❑ M„��,P�e Fem��y/Co„do ❑Warenouse <br /> � PUbllc �Jtorage � Publlc Water <br /> "'Any earth movement may require ❑Com m e���e� ❑O�ne��specify) <br /> MCWD review 8�pertnits. ❑ I„d„s«,a� �P��„ate We�� <br /> MlnneheM1a C�eak We�e�snea D��«���(MCWD) �O�na�: (�Pa�iry� <br /> 18202 M�.,�ezo.,ke B�„d r�j I�C�E' {fcM,�i�(`Cc�'.�r. f <br /> Dasp�a..a�,MN 55391 � C�� n ��J„' <br /> Pho„a: 95Z-471-0590 1�U 6 h ``�Ey � <br /> F e x: 952-471-0682 ��,- <br /> nhwcraek.or <br /> EstimateO l.onstruction Veivation �¢xclutling land, � ��. '��1�� <br /> —�T <br /> Les<UPde�ea: 4/26/2011 <br /> - 19 - <br />