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h <br /> i./�� U�"� <br /> ��l�` <br /> ��.. <br /> � �� � � �^{ DateReceived: ��-1�'��i� <br /> Total Fee: $ ��, � r!k, • i, r <br /> Entered By: ;'�, '��. Permit#: f� /���'6 <br /> CITY OF ORONO - BUILDING PERMIT APPLICATION <br /> All information must be submitted in full before plan review will be started. <br /> (please print all information) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> THE APPLICANT IS: (circle one) OWNER O CONTRAC OT R� <br /> ` � <br /> JOB SITE ADDRESS: 2�65 Kelley Pkwy, Orono, MN ZIp. 55356 <br /> (Orono Professional Center) <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? <br /> ❑ Yes ❑X NO If yes, a special enent permit is r�equired with Police Department and Ciry Council approval <br /> 60 days prior to the event. Shuttle bus sernice N�ill be required unless applicant demonstrates <br /> sufficient on-site parking is anailable. Non-permitted events will not be allowed. <br /> NAME OF OWNER: � �illofacial and Oral PHONE: (home) <br /> Dr. Abdollah Rahimi (work) <br /> MAILING ADDRESS: CITY: ZIP: <br /> CONTRACTOR: Scott Builders, Inc. PHONE: 763-684-0000 <br /> CONTACT PERSON: Dave Larson MOBILE/PAGER: 612-804-1041 <br /> MAILING ADDRESS: 12 E_ Di vi�i on St_ CITY: Ruffalo ZIl': 55313 <br /> STATE LICENSE: # N�p EXPIRATION DATE: N�p, <br /> ARCHITECT/ENGINEER: Paul Meyer Architects pHONE: 763-557-9081 <br /> MAILING ADDRESS: 15650 36th Ave. N #170 CITY: plvmouth ZIP: 55446 <br /> NAME: pa>>� MPTeT- REGISTRATION: # <br /> TYPE OF WORK: New Home Addition Accessory Structure <br /> Move Home emo Alteration (ie: Siding, Windows) <br /> PROPOSED WO�tK(describe in detai�: �� ��Y� `� ����� •�cJ7� p� <br /> �e�Sc �� � �c r <br /> STORIES: SQ.FEET OF EACH FLOOR: �! 1 Z S 59'L�P �� <br /> NO. OF BEDROOMS: N A GARAGE STALLS: ATTACHED DETACHED_ <br /> ESTIMATED CONSTRUCTION VALUATION(excluding land):- f-S'd� �b <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 the State Building <br /> Code;that 1 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 pla ,l <br /> � <br /> APPLICANT'S SIGNATURE: � - - —DATE: �� /� b <br /> 31 <br />