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To: City of Orono Page 3 of 3 2016-01-06 21:23:07(GMT) 1 61 22881 957 From: Donnie Fitzsimonds <br /> • �w�y �� ���maea <br /> . , E3�ilc�'s�� ��rt��t App9s��t��� ��r B4�air�t���n��� ���ai���tn����' #���nc�d�� <br /> �� � �si���3a�'�r'�a�, �.��.m�a�w�c. ���ta����, �'�ry'��.��i°� �w't�.. ,�. �� �:��`�4��,"�`"�.8�a�� �A'��-�¢��`,"���,��r,� <br /> ���� � �� � � �l�l��Jr«g�Rc9riress� � �� � � � �O 'Q(�O � <br /> /`�'"°1�` �� PC)Bo:�06 P�rmit n�tmber 1 <br /> � � �� • – <br /> Crystal Bay, MN 55323-Q�G� �1�1 C;�te received: <br /> �, r �.-�.�:� <br /> , �. <br /> � _ StreeiAdn`r�,s,s_ � �,Y � �eceiv,;d by <br /> � � �-��� .� ' � � 2�5,?KPil2y�t�arkway � � � � � , <br /> � � �'"�° . j.`� � � Pian review fee�� �I�� , <br /> � �`,'',��� „= � C?rono, �UtN 5535& � � <br /> . . . . 1..�„ . . . . . . . . . . . . . .. . <br /> . .,._ .. .. . . . <br /> .p,n,ain 96,?,���'�6D� Fax: 952-2�49��Fti �r,F�-,��_��<��g��.r�;,� Tota!�ee <br /> � 'Ft�is applir,alic�n fc�rm rt3ust be campiPtpd in ful�ai�d ail requsrec��nforrnatiPn rtrust�e su � ��. ' �� .Z Z <br /> incamplete a�aplicaiions witl�e ret�rned, (Ptease print) � J.J <br /> t���dERAL 0�}F�RNtAT@Gs�d: l <br /> �'ob 5ite Address: ��� �,,���''�' � d��= ,���+' � <br /> VYefl this�e a �arad��t tiarnes Rernrxd�lers Showcase b��m�[�6s�lay�l�me? �'�es � <br /> �y�es,a s�.�r.ia!qvent perm,f is reqtn,��y,itn P�h1:e Cep tUn nt arr�CiRy Counc�'!appro��ai 8C c��ys,�nqrlr�thg event. Shi�t3le t�rts se���l be <br /> rrquirec a�/ess appliCard c7'�munsG�atev,sut�rw.�,�t an sit;�p�rking�s z�vaiiab;a. IVun-vc�nr,iltetl ev�7r?t5 wi71 not Y�allnu��d. <br /> GC3NTi�AC"i'C3Ft I AF�4�LiCANT lNFC)F'tNtAT(t�N: <br /> Narr�e: � 1�, u� 7�,� ��� <br /> State�.�c.�nsti# _"��`'��. �,�_�G'�'��,�_...�-�.��.�._-- <br /> __. . _.. <br /> _—.,d� c�t����--�-� �xpiratic�n C?afE: ,�'��1 ,� — <br /> Lead Ccrt,f�caiior�lVuir�ber ,,,`.a�> _ �xpiration Qate: - <br /> -�f-'T r ' - �P t� <br /> (for work on�omes thaf were c�snstrueted priQ�0 9�� __. —�- <br /> �'hone: (ce{!� '�f�� ' , F f 1 �y /:. ,�'� . �'' <br /> .. �__�.�?,� f�� ��f r�� _ (office) i�,� �'!w^f 7 f'� ,✓ <br /> Ma�I;n�Acidress: �"° , -?--`,�� ' . �,.:.� <br /> � -�� � �-s �.�r'� Z[P:�J�,,r,�-'��� <br /> �4Dtltdt:t F'PfSCIi" ' r fw ..f�1,��� �:�. .__ -_�� ����-�- _._ �_.�. <br /> � �`���``/�`�-�`� �����d�,� ��PPlic��r�t�i�: Gontr�czor� ,� Homec�wn�;r � <br /> .. � �;T1�1���2i7t��:1���X �. � r r� � � ��.___ � .. . �(Cir�le�tie) <br /> C� r �i'�10.�ft����'u+�1�,,-p,�s:����.C3_._.:� ° /'v�_� c�.� ..T i�i,`�'�-- <br /> --._.__. �-�--=��' — -- — <br /> ��ac�P��rrv csw�t��rr������Tt4r�: <br /> N�rr�e. �e� �-1 r� , , <br /> . <br /> ,- <br /> P�ione{day}: � `s` , 'I'>°1 -7�'_:T':T'�-�: <br /> - � _.:_.. : <br /> �__�Jj '� `:` "_ – <br /> Adc�ress, n �' _ <br /> _ .. ; <br /> � ._-�z� �.��=�" ���~�,=���"�. c:t�:l..�i�'��,� �_ z��:.:.�._ ��- � <br /> ..�na�!attd�or Fax� /Y2�;<1�� „ 1 ��' <br /> � _�t -.�i�-��''� <br /> _�. _ <br /> !t���.__ w <br /> ___ <br /> l�6�LJJECT l�1FOR�rr9ATlCDhl: bv�;rai� ro'ect de5cri tian ��s'�. 1t E:, ` s ' . , <br /> _ —_._— _ —.P 1 �? �� -��� �� �r�.�,�'� ��,����Jd� la��- C':� ; ' <br /> Type af Aro'aet: -- _ <br /> ! �Any earth mave�r�ent may�Iso req�irc <br /> �Coor(s) -�f��h:� �J��i�� �}}�e��oael� � � MCYYIlE3 revio�v�& <br /> [�,Fire C7a�t�age Perm�ts:' <br /> �i�Re-r�qt,ast�ttalt # �t �<e�air � �❑Storm C)amage M�E-�n�:ha�ia Creek�UVaY��she�[�istrir,t(fviCV�/t�) <br /> i ��C}Re-rnaf,cedar t'�� �'i� [��Restoration E � � � � �g7��'•Niinrretonka 8tvd <br /> ^ �L�� (]4�iaterl)amag2 �)eepf�aven,M�1 553s1 <br /> � �f�e-ronf,aiher{sp�c3�yy Q S�dirt �j"�'' Pho;�e: 952 4r1...(7550 <br /> 9~ �" ❑C7ther:{speeiiyj <br /> ` [�,U4`Indev��'s)� �.3�u�<''__ Fd,� �52-471-L�6a2 <br /> - ._� .—.. . , � .�._ . V(S x,k +Y 7� '�i.i3�''_.a.,,c C�,.c r�� . . � <br /> �Es�ima�er� Coa�s4�u�tian Valuation of�Pr��ecE�exciud7n� l�vadj � �� rA �;� � � <br /> . � � �J .✓::.v j .Jsl.�} �l-l.J"�3ti,iFy . . . . . . �� . . . <br /> �Pr�LlCAP+1�ACK�(?'�NL�[7C'a��i�lVT; <br /> .+_._ ` _ <br /> __-- ..___- <br /> ' + �grees#a�rovide ail i� �,r�-,a:ior rec}uir�d or rcq�ested by the C�uiiding U��a1lrn�;nt; <br /> ; � • � Cer�fies Yhat the irfqrma`�ora supplieti;s true and correct t�th�best of�hist?��r,��[�y,�i��q�_ The e�soiicant r�co�nizes that thPy ate�� <br /> ; y�kely respr�n5ibl�fc>r subr7iiliir,g a complete a�plir,atiun b��r4g aware that tipon fa{lure to do sc�,;�ts staf�has tto altEmative but tc ' <br /> � reject it unhl'it is ompiete <br /> � • Snnie or alt ,�f h intcri�atun that you are �:s�ed fio prov�de cn this applicatan is class;fied tay Sta{;; law a� eith�r pi;vate or <br /> � cnnfidentiai_ Pri�✓ate datc is i'�farr^ation which yeneraliy canno��E gi�,er,to the public but can be,yiven to th2 slibject o#th�data, <br /> �an�tder3tia!data is information which genera�l���;a�ro! hP given�o m,fic�r thF }�ubEic;t7�+,he subja�t of,he.ciat�a. C�tFr purFrc;e anci <br /> ir:t�nd,.d asa ofthi5 rnr^rm�t(at3 is to artnual(y�update our�records�a�d;e;;or�zls�s otk�rrgoWernrnenta(a er,r.ics�re�uirrd�b <br /> ou eruse,o su� �r�he-'ifc>rrnati n,the;�licatior ma rsai�e issu�d. 9 9 Y'rabv: I� <br /> ,.._�_.._—_'_�c{�` . <br /> ��.. -__-._ ._.'L. .. <br /> l�;�plic�r�t's Signaiure: �M'�K�..��: �AT K �'� ' tJate: ����+ _....� <br /> .- r ,�'�,���r`�`e <br /> �,vner's Sign�ture: �.�'�'a`"�. C3aF�. l�' �:t,�� <br /> ,/ �--'- <br /> G�� �e►�T'L �/Z7/`� <br /> . ___.� <br /> "l <br /> _ __ • <br /> �n k�,yo� ra�o%�cr� �v�� r��di � � <br /> av'a �orGC !��»�', /�� 1N �n a�1iU� S c f�'� �' <br /> C � �- �� <br /> 1 <br />