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, • Total Fee: $ �j� `I�� Date Receiv : `'I-�/�c i {�%� <br /> Entered By: >� '� Permit#: /�� ?�] �? � <br /> n CITY OF OIt(�NO - �UI�I)�'�1G PERMIT APPLICATION <br /> �N ' �� � <br /> ' ;;��\� A11 infornnation must be submitted in full before plan reviQw will be started. <br /> ! r. (please print all informatinn) <br /> THE APPLICANT IS: (circle one) OWNER OR CUNTRACTOR <br /> JO�BSITEADDRESS: �-�d5 Crystal Bay Road ZIp; 55391 <br /> Wayzata , MN <br /> Wil�this be a Parade of Aomes,Re��delers Showcase Home or other Display Home? <br /> ❑Yes ❑NU If yes,a special eveni permit is rer�uired with Police Department and City Council approval <br /> 60 days prior to the event. Shuttle bus service wi11 be required unless applicant demonstrates <br /> sufficient on-site parkzng is available. Non-permitted events will not be allowed. <br /> NAME OF OWNER: RUDY WICKLANDER HOMES pi-�ONE: (home) 7 6 3 n 2 2- 9 1 9 2 <br /> (work) <br /> M�ILINGAI)DI2ESS: � 5a40 P,otawatomi Str���. Andover �jp. 55304 <br /> treet NW Minnesota <br /> CONTI2ACTOR• Rudy Wicklander Homes PHONE: 763--n22- 9192 <br /> �ONTACTPERSON: Rudy Wicklander MpBILElPAGER: <br /> MAILIf�'YG ADDi�ESS: 1 5 Q:4 0 Pc�tawatomi ��'y; Andover ZIP: S 5?0 q <br /> STATE LICENSE: # � ?8 8 S t r e e t NWEXPIRATION DATE: 3/3 1 /2 0 0 7 <br /> ARCHI3'ECT/'ENGINEER: Pertinen Planni $�IONE: 763 ?80 8t104 <br /> MAILINGADD�tESS• 9 i Baltimore Stree�ITy• Blaine ZIP: 55449 <br /> NAME: Don Pertinen REGISTRATION: # <br /> TYPE OF WORK: New Home XX Addition Accessory Structure <br /> Move Home RemodeUAlteration(ie: Siding, Windows) <br /> Any earth movement may require MCWD review and permits! <br /> PROPOSED WQRK(descpibe in detai�: <br /> tear down old house/remove/ rebuild new home on site <br /> STORIES: �_ S�.FE�'I'OF EACH FLOOR: �� �D /fJ� / �y'. <br /> � <br /> NO. OF BED�tOOMS: _� GAR�GE S�'ALLS: ATTACHED � DE ACHED_ <br /> ESTIl0�A3'�D CUNS�'RUCTIUI�I VALUATION(excluding land): $ =���, UUD, �� <br /> , <br /> I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; <br /> that the work will be in conformance with the ordinances and codes of the City and with tre State Bnilding <br /> Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be <br /> in accordance with the approved plan. <br /> . <br /> APPLICANT'S SIGNATURE: � DATE: J�'�Z'OL <br /> /� <br /> :f <br />