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VV�f..V���V ■ V�\���� � r�� � V�V/'1� �V�� <br /> � FOR NEW STRUCTURES, ADDITIONS � �� �$�• �g <br /> MailiPO Box 66� 1'��� ��� Permit number. .� ., %� ` '-/_� ;' <br /> '������ r <br /> ��� Crystal Bay, MN 55323-0066 '.' Date received: �.%' 1� !4 <br /> � Sh+eet Addr�ss:' ,-- `,`, ,r,� Reoeived by: �i� � <br /> 1:iZi � <br /> s. ��' 2750 Kelley Parkwa� f� . s: �' �=;• P an review fee: � , j (^ , �� �'�i <br /> ���'Y' sHo�"�`G Orono,MN 55356 `�',=`�_��I -;: _ _ ...,____�.___ �Z.iU� <br /> Total Fee: � <br /> Main: 952-249-4800 Fax: 952-249-4616 www.a.orono.mn.us <br /> This application form must be completed in full and all required information must be submitterf. <br /> lncomplete applications will be r+eturned. (Please print) <br /> GENERAL INFORMATION: 1 �f <br /> Job Site Address: d� � li�e,rl� /� ��. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes o <br /> Kyes,a specfel erient pem►Itis►eqribed wlth Pollce Departmen2 and C�y Coundf appmval SO days pn�orto the event. ShultAe bus serv/oe ! e <br /> reqruired unless app/k�nt demanaV�lea suArcie�rt on-sfte parldng Js avelleb/s. Non-penn/lted e►�r�ts wU/rlot be allowed <br /> CONTRACTOR/APPUCANT INFORMATION: <br /> Name: S-f-�r�z�.✓ooc� .Z-.G• <br /> State License# G S S Expiration Date: <br /> Phone: cel "I . 7, �6 7b �ffi� t a. �6�. OD <br /> Mailing Address: � S e E. C' � �,✓u «• G ZIP: S' <br /> Contact Person: S i/en Gvs fr f=S • Applicant is: Contractor I Homeov+{ner �c�,on.� <br /> Email and/or Fax: Q. Sf- �iMb� . Lo� a-s o,-�- s' ���v oo`( . c.nr.� <br /> PROPERTY OWNER INFORIIIATION: ,�/ <br /> 1'��.I'IVIC �- NQL�i�°�.. WAShU t� <br /> Name: I� � („�a5� c1'}'G �- /VP�+/S���ti <br /> Phone (day): — Z o�� r <br /> Address: G �/� Cit : ,/►/1�,r,►.� ZIP: s5 ,3�Gf <br /> Emai!and/or Fax � � ,n <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> wame: rJ' I►'�1t S �,✓�1 G:G: <br /> Phone(day): ' . � <br /> Addr�ess: t ,�� �/' C' : � Z.•L'1�c� Zlp; �3 <br /> Email and/or Fax: �v1� U]— S�o�� .G a✓� <br /> . <br /> PROJECT INFORMATION: Descri ' n of 'ect: <br /> 1.Type of ProJact 2.Proposed Use 3.Structure Type 4.Sewaye Dlsposal b <br /> Water SupP�Y <br /> New Construction �Sirigle Family with �Reside�oe <br /> ❑Addltion attached gerage Garage/Ac�cessory Bkig. �PuWic Sew�ar <br /> ❑Acoessory 8uilding ❑ Single Famiy with ❑Dedc <br /> ❑Relocation detached garage ❑Offioe/Commercial ❑Private Sevu�r <br /> ❑Other.(spedy) ❑Mult�le Family 1 Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> *`Any oarth movement may also require ❑Commercial ❑Other(specify) <br /> Mcwo re�.w a�mtts. ❑md�sa�ei ❑Privete weu <br /> Minnehaha Creelc Waterahad DiaMd(MCYVD) ❑Other. (spectifY) <br /> 18202 Minnetonke Blvd <br /> Deephaven,MN 55391 <br /> Pha�e: 852-471-0590 <br /> Fax: 952-471-0682 <br /> in <br /> Estimated Construction Valuation(excluding land) s 1 ,C3S(7, ��, (�T <br /> .-- <br /> ,�;`�so�I ���- ��! - 3 s�� <br />