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� '� � r <br /> ' � t <br /> • � il . . <br /> t <br /> � Ci�r o� �RONo � <br /> ; <br /> BUILDING PERMIT APPLICATION : <br /> F�R NEW STRUCTURES OR ADDITEONB , <br /> �A F Malnng Address: Permit number. 4/3 -O� �.� <br /> �y � P08ox88 <br /> 0 Cryeial Bay,MN 55323•Q088 Date recalved: <br /> SttgetAddresa:, Recelved by: ` / � �• . <br /> �� ` - 27B0 Keiley Parkway Plen revlew fee: �/3 `� OD 7 . <br /> � Orono,MN S53S& <br /> �"�kasrto��' Total Fee: <br /> Maln: 9b2•249-4800 Fex; 952�249-4616 �y,y,�j.arono.mn.us <br /> Thla applir�tion farm must be campleted in full and all requfred iniormatlon must be submltted, <br /> tnaomplete appltcatlans wli!be retumed. (Please print) <br /> GEN�RAL 1NFORMATION: <br /> Job Sfte Adcfress: r � �e, P I nG� <br /> Will this be a Parade of Homes, Rernadelers Shawcase Home or other 171aplay Home? Yes No � <br /> 1l yes,e spedal everrt p�rmft ls requJrecl wlth PoAae Aepa�rnent enct Clty'Gound!e�vval QD days prfor fo the evanG Srn,�Je bus ssrvMe wl!!!be <br /> requkad q�fess aAA��cant demonadates aurth�ent on-slt�pe�fdng 1s evw�ebfe. Non�ert»ltted events wnl nvf be e!lowed. � <br /> CONTRAC70R 1 APPLICAt�T IN�ORMATfON: � � : <br /> Name: � ,��4-ta� Ho wu�S — � <br /> St�te license# p�L z,�,a�p}� •Expiratlon Dete: 3„��j � <br /> Phone; celi "k offlce Z 3 N�S 3 33� <br /> Malling Address: d� -�+ Cit : +ti- Z.iP: ' 6 � <br /> Contact Persan: n� �. ' Appll�ant ie: on rac or I Hameawnsr �c�cio anel <br /> Emall end/or�ax; 1 0 �• o <br /> PROpERTY OWNER INFORMATlON: ' <br /> �vame: . �, � q�l e.. ���k L��- , <br /> Phone(day): voo � � <br /> � Addrasa; c, �� o�• 50 N1fo���a��+�C, �r City: `��1' PaJ ZIP: rj � ��� <br /> Email$ndlor Fax ���,����,r�n�� __ ' <br /> r <br /> ARCHI"tEC'F!ENGiNE�R INFQRMATIQN:, <br /> Name: R� �, ( v�✓�n v� <br /> Phone(day): �-Z- �q� �1 7� � <br /> Addre$s: ,� G�y�.ro r City: ��S� ZI P, J'rS 36 <br /> �mall andlor Fax: • . <br /> PitpJECT [NFORMATlON: Descrl tlon of ro ect: � <br /> 1,Type af ProJect 2,proposad Use 8.8tructure Type �d.8awag�ptspoeal& <br /> Water 3upPty <br /> �New ConetrucRon � �.Single Famity with �Residence <br /> AddUton atmcher!gerage 0erega/Accessory BIdB. �Pubitc Sawer <br /> ❑Aa:essary Bufldln8 � ❑ Single FamEy wfih ❑Deck <br /> ❑Relocation dotaehed garage []C3fflcalCommercisl �]Prive�te$ewer <br /> ❑0lh�r.(speci�y) Q Muftlpte Family/Condo ❑Warei�ouse <br /> ❑Publlc ❑Storage ❑Public Water ; <br /> •'Any earth movement may also require D Commerclal ❑Othe�(epecify) <br /> MCWb r�vi�w 8�permlts. ❑Indusirlal � �Pdvate We8 <br /> Mlnnehnha Greek Waterehed C11atr�ct(MCYVp) [J 01her.(apeclfy) . <br /> 18202 Mimtatordca Blvd <br /> Deephavan,MN 55391 <br /> PhcMe: 982-47i-Ob40 <br /> Fa�c 952-471-0882 <br /> � , Esilmated Constructlon Valua�on(exduding land} � a 4 / ��. 4Z� <br />