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' +9522494616 T-657 P.001/005 F-658
<br /> Jul-_, ���� 10;02am Frum-CITY OF ORONO
<br /> ��.3�-i�t�1 �� 'c� d C.� i�'1C �/� I�,�,� QC•tt�.l 1� S� }.�p
<br /> J q
<br /> C�ty of Orono
<br /> �uilding Permit Appfication
<br /> for New Strucfiures or Addifiions o 00 �
<br /> MailingAddress: Permit numbe�: aDDg–D6`{a,7
<br /> O��,�0 PO Sox 66 —
<br /> Crysial Bay, MN 65323-0066 Date recaived: 7-Z�–D �J
<br /> �-
<br /> ,� � StraetAddross�' Receivad by: �
<br /> ��a � 2750 Kelley Parkway ��/ P�an•review fee: !.7� d C� Z 9�
<br /> ��Esso�.�`' O�ono, MN 55356 aoog_oo�ab ���i/D
<br /> Total Fae�;
<br /> Main: 952,249�600 Fax: 952-249-4616 www.c�.orono.mn.us
<br /> 7his application#orm must be completed in f�ll and al! required informati�n must be submitted.
<br /> Incomplete appfications will be returned. (Pfease prinr)
<br /> GENERAL INFORMATl�N; _3�1S� � ,
<br /> Job Site Address: �� ;��, ��s=��, f��
<br /> Wilf this be a Parade of o�es, Remodelers Showcase Home of other Dispfay Hoine? Yes � No
<br /> !f yes, a special event permlt is required with Police Depertment and Clty CounCil epprov&1 60 days prior ta th�evHnt. Shutt(e bus selviCe will be
<br /> requin9d unless applrcant demonStrefes Sufficient on•siro pprking is aveilable, Non-permittod evenfs will not b6 e!layveC,
<br /> CONTRACTOR/APPLlCAN�' INFORMATION:
<br /> Name: _A1� : C�i�•c�< S .- �.:, �1S ���
<br /> State L,icense# Expiration C�ete,
<br /> Phonc: "4�j office � _ _ C' �'l (cell)
<br /> Mailing Address: = --f ' ,.-k' c Cit � C.:�.w_Kic�� ZIP: �-�'l/ 7
<br /> Contact Person: - � �. Applicant is; ontractor� % Homeowner �c;rae o�e}
<br /> Ernail and/or Fax: ti ,- .� � , S- , ' � L�S'_y cj
<br /> PROP�RTY OWNE�2 INFORMATION: ;: ,� z�
<br /> .
<br /> Name: ���'�-.��-f���ti(�:�� �'�G�►�, � ,� J c•., l� a/r� ��.f� -., • L r�- 3[,C =�3s�
<br /> Phone (day}; �,�`,� ; �� -,� �� y
<br /> Address: –' City. Z1P:
<br /> Email and/or Fax -;�'�1 �;;, �,�„��� �,{�{ , � ,..3.�_ -
<br /> ARCHITECT/ENGINE�R {NFpRMA710N:
<br /> Name: ,� .� �� ��.•� j����r_-`�� �����. .✓ � .
<br /> Phone (daY): 41./-� - .� '_.� � y 7 il�
<br /> Address: l S r?.�,�, �.� � a.-.�( J��.� ��� City: �/u�_�� ZEP: �� -� °�''� �
<br /> Emai! and/ar Fax: .�b,�n ,,; � ,. ✓: ;Ik^cGi. �f-r� •Fs �t, c�;v� � --
<br /> PROJECT lNFORMATION: �Q,�,c� ����
<br /> 1.Type of Project 2. Proposed l Ly�L,�^ n � 4. 5ewage Disposal&
<br /> '� `��'� Water Supply
<br /> ❑ New Construction ❑ Single Fart ��-e ��-�
<br /> ❑ Addition attachod ;ory 61 - - i
<br /> ❑ Accessory Building � Singke Fa� ��f1G <y���. L���– l �
<br /> ❑ Relocation .T, �� � aatac�,ed �� - 0 I�aa�� ;ial
<br /> �Other: (specify) �+-N�.'_�.�N[. �� [] Multiple Fs � � � ,�
<br /> "`Any earth movor �e�,�/L �v-ex- �ercia, _ P�6L dv�Gc� - q��a,�
<br /> " _..._. . ,
<br /> MCWD review& p, .�r� tria! � ��
<br /> M�nnehaha Creek Wa �y�,�j ` V' � ; (specify) �� h�,�r
<br /> 18202 Minnetonka sl� /
<br /> Deephaven,MN 5534 � _ !I n/ � � La��- - �� qe
<br /> PhOne� 952-471-059C °JI•C'�" C�/�oast ,��dDQ �Q�_
<br /> Fex: 952-A�1-0682 ���� .
<br /> www.minne ahacreak
<br /> Estimated C�nstr (',�� ) $ _
<br /> T
<br /> - Zo - �'` 7� o d � L a-6-�� Cjt�L/Il'C�
<br /> . �,.3 � S'� D
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