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DEC/0 2009/�RI 10' 3� AM Groom Constru.ction FAX No. 952-929-4779 P. �OI
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<br /> otul Fee: $ I Date Received: �- /�/ i' c `%
<br /> +�tered By: Perxnit#: o;i�b�' -0 0 ,�7-L�
<br /> CYT'Y O�' ORONO - BUILDTNG PERNIIT APPLTCATION
<br /> A.����o�'[r�at9o� must be submitted in full befo�re p�a� �evaew wiiU be started. �
<br /> (please print aIl anjormarfon) .
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<br /> .APPL�C.A.�TT'�S: (cirele one) OWNER O CONT ' ,�� �
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<br /> 08 srr�AnD�ss: l lo�S �o��4+`���� Zrn;i 5 S 3 q 1 � ��, .
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<br /> ill this be a Parade of Homes,Re�aode�exs S�owcase�Tome or otrier A�s�lay T�ome? ��ti , � .
<br /> ❑�eS ��o Ifyes, a special event per»:tt ts�•eguil'ed wizh.Police Depa�•nne;yt and Ciry Council approval ��, �
<br /> 60 day,�p�•ior to the even�, Shutlie bus service wf!!be regutred unless applicant demo�sn•pres ~
<br /> sufficient or�site parking is avatlable. No�pe�•»itrred evenis w111 not be allowed. ��:�-� (
<br /> AM�OF O'WN��R: �i G�a�- _�n�,C,a�-k �orrE: ��,o�e�9 5Z•4']3•Z Z q 0 ',J �,�"
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<br /> ING ADDRESS: 1 le� �pT��- C�': ZIP: ��3g� ��;� >.�
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<br /> ONTRACTOR: r���1-t-,d,�.s.��+r1-t on,-pHorrE: b\2•2�1•n1 1 0 � ��`�'y
<br /> ONTACTPERSON: � ��p MOBY.�E/PAGER: b�2•8•tp • �q�r'7 ,����
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<br /> G ADDRESS: ` CITY: � � � ZIP; `�
<br /> �e�s�.o.li.�. �s�1, �,�, � �
<br /> _, xATE LTCENSE; # .E�YRATION DATE: �. \�`-� �k�
<br /> C�.�CT/ENGTNEER; v�[. PT�O +: �j�z- �J ll�� �
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<br /> �TC ADD�SS: LI�5� r+ rL. CI'TX: �'e�w► ,r�-� ZTF: 5�`I'�' ^��
<br /> A.ME: �Yk� Q,'�K�'yz.,Z- RTGZS�A.'TION: # -v�
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<br /> E OF WORK: New H,ome Addition Ac�cssory Structurc �
<br /> �ove�Tome Remodel/Alteration (ie: Siding, Windows) �� ��
<br /> Any eax't17� 'movement may re uire MCWD review and permYts 1 ���,
<br /> OPOSED WORK(describe in detai�: v I(� l�� f ��z, ,� � `�: ,_���
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<br /> ORTE�: �� `S .FEET OF EA.CH k`LOOR: 4 (S !� �
<br /> O. OF$�DROOMS: � GARAGE STALLS: ATTACHEIk' � DET.A.C�IED �
<br /> Sx7MAjI'ED CONSTRT3CTION V.A.LU,A,T�O�T(excluding�and��� � a � ���"�
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<br /> T eraby apply for a building perxnit an,d Z ackoowladge that tl�e infoxAna2jbn above is complete and accurate; � � V
<br /> t tt�e wor�wxal ba xz�coz�formanee with the ordinances an.d codes of`t�,e City and wxt�tk�e State Bui�dx�g � ,v
<br /> de;that I understand this xs z�ot ap�zunit and work is not to start wit,�iout a permit;and that t1�e work will be �,�
<br /> ' accordance wit;h ihe approved plan. �
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<br /> LTC.�Nr'S SIGNA A.A_TE� !2•� •O 9 �
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