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� �7'T, �'!��>S7`iN� mATrs'Q <br /> City of Orano <br /> Building Permi� Applicat�ort <br /> fior New Structures or A,ddition <br /> Maiifng Address.• <br /> �Q� PQ Box 58 Permit / � ��Q <br /> Q Crystal 8ay,NI�I 55323-OG56 <br /> Str�set Add�ess' Re d . <br /> y ,�' 2750 Keliey Pa�y <br /> '��a ��� Orono,MN 55356 �,}� 113� Plan <br /> �xsHoa Mairt: 952-259-4600 (�'� To�l Fee: <br /> —_ FBX: 952-249�616 w ww ci.rrono m� u5 <br /> 't'hiS�pplica6on form rnust be cornpfeted in fuR and.ait required iniormatian must kse btnitted. <br /> tncamplQt�appliGations w11F be reburrtetl. (Please prfn#) <br /> GENERAL INFORMATlQN: C'- <br /> Job Site Address: a �4 �DX ST <br /> Wfll this be a Par�3de of Womes, Remodelers Showcase Home or other Dispiay Home? Yes No <br /> RY�,a�PeCie1 evant permit is requlrod w;m��e pePartment�d LYIy CarndJ aAy+»val 60 Hays yrror to Hre evenL ShutUe Dus Senia:e will bs <br /> t�q+r►�ed enl�s�9s 8ppticant derr►anst�tes suA9rfant On-sr7e pario�ng!s avaitable. lubn�pem�dt�d evonts w�7i nat ba afloweo. <br /> CONTRACTOR/APPI..ICANT INFORMATION: n <br /> IVame: /�_�'��'" �l ' SC'�/�� <br /> 5t�te Licenge# Expiration pate; <br /> Phone: cell ! ^- C�'! office ,_ � � � <br /> flAaihl�g Address: , p. a C' : �*] ZIP: <br /> Contact Person: �C/�,�;,�J � Applicant is� oritractor I Nameowner �crwo on.� <br /> ) <br /> Email and/or Fax: �p�Z/.�,�/��D,��,� �Jjyy00. C'O/�j <br /> --� <br /> PRQPEF�TY QWNER INFORMATION: <br /> N�me: „SGJ/�AJSO� /�D � <br /> Phon�(day): ,�- � p- <br /> ,Address: O J9h7 Ci : /YJq/�'! � 7JP: .S.r�'(7�C9 <br /> �mail andlor Fax �63-- ' �(� ' <br /> ARCHITECT/�NGIN�E IN�ORIYEATfON: <br /> Name: �'[�'IE'S'' �I11� <br /> F'hone(day): - ' � <br /> Address: O d /'' /�� Ci y ,�iv �����P � �� <br /> �ma��and/ar F�x: .5 -Og <br /> PROJECT fNFQRMATiON: Descri 'on of pro ed: ��Ul�r� ��r�/N/�b� G�1�� <br /> 7. ype o Project 2.Proposed Use 3.S�tructure Type 4.Sawa 17is osal& <br /> � A <br /> Waber Supply <br /> ew Constrt,ction Singie Famity with Residenoe <br /> (�Addition aLtached g8tege Garsge!Acoe$sory Bldg. ❑Public 5ewer <br /> Ac�ssory BuikNng [] Sirrgle F�mily with I�Deck <br /> Relacation detached 9srage ❑Office/Commetci2l ' ete Sewer <br /> 0 om�c��> a++�►��F�,;n����b o��,�� <br /> ❑Public ❑Storo9e ❑Pubibc W�ter <br /> ""Any earth movement may t+gquire [�Commerciaf ❑Oth¢r(�} <br /> �wo rewew���. ❑mavSa;ai C7 Pr�►ate Wel! <br /> annnenana cresic wa�eTsnea o�;a(nncv+ro) p other,(speaty} <br /> 182D2 Minr�tonka Blvd � <br /> Deepheven,MN 553g1 <br /> PttO�e: A52�4�1-0590 <br /> Fax. 952�a71-0682 <br /> n <br /> �sttrnsted Construction valuatio�(excludirty land) � <br /> � Psdcet Lt�st Updat�d; p4/79/2013 <br /> Page 22 of 23 <br />