Laserfiche WebLink
1 � � � <br /> ' � 1 <br /> � <br /> Ci�nr oF oRONo <br /> BUtLDING PERMtT APPLICATI�N � <br /> F4R NE1N STRUCTURES OR ADDITlONS <br /> � n� Ma!!Mg Addresa: Permit number: D/3 -Ba �� <br /> j��� PO Box 86 <br /> 0 Crystal eay,MN 553Z3-0088 Date recehred: <br /> Sbeet Addreas:. Recelved by: � � �• <br /> �y� � 2780 Kelley Parkway Plan revlew fee: �/3 `� 00 � . <br /> �'�$65H��'�G Orono�MN 55358 , <br /> Total Fee: <br /> Main: 652-248-4800 Fex: 952-249-4616 yp�pp�,�.orono. n.us <br /> This appUcadon form must be complebed in full and all required infortnatlon must be submmed. <br /> Incomplete epplications wlll bs returned. (Plesae print) <br /> G�NERAL INFORMATION: <br /> Job Slte Address: ; �► t¢, P I�u�. <br /> Vlfill this be a Parede of Homes, Rernodelers Showcase Home oc o�er Dlsplay Home? Yes No � <br /> !t yea,a speda!event pemdt Is requrrod wiOh PoNce Rspsrfmwrt e►�d Gfy Cound!epptvvel e0 days pdor b the eve►rt. ShulUe bw sarvtce wNl be <br /> rsquhod wdsas appll�nt domonabatss auAfclent o»�site peddr�ts avallable. No�rperm)tted ewnb wi9 nd bs alb+Med. • <br /> CONTRACTOR 1 APPLICANT INFORMATION: � <br /> Name: h�F-la� Hc � <br /> Stete License# p�� y��Se �Expiration Dete: 3/ 3 I � <br /> Phone: cell •�ti oiflce z 3 �ZS 3333 <br /> AAeiting Address: D -L^+ C : ,� w Z1P: 6 � <br /> Contact Person: �• ' Applicant is: n c or 1 Homeowner �c�aio one� <br /> Emall and/or Fax: 1 0 �- a <br /> PROPERTY OWNER INFORnAAATION: ' <br /> H9(11@: L4k4 SOJ�[P <br /> � Y�� � � <br /> Phone da y�,, o D <br /> � Address: �l,� �1✓b Su� SD NI�eS 5i�ailin� Qr City: ���� PM/� ZIP: rj S ��� <br /> Email and/or Fax ��e� s�s _�on v ' <br /> ARCHITECT/EWGINEER INFORMATI N:, <br /> Name: ��-�, G� �q v�- <br /> Phone{day):� — �� H � <br /> �aress: � �,7�.,0 � c�tv: DSS� z�P: 5-,�. 3b`l <br /> Emafl andJor Fax: • � <br /> PROJECT INFORMATION: Descri tion of ro ect: <br /> 1.Type of ProJect 2.Propoeed Use 3.Structuro Type 4.Sewage Dteposal d� <br /> Water Supply <br /> �New Construction �.S(npb Family with �Resldence <br /> AddfBon attached garage Garege/Axaseory Bidg. �]Public Sewar <br /> ❑Axessory Bulldlnp ❑ Single Famdy wHh ❑Dedc i <br /> ❑RelocaUon detAched garage ❑Offlce/Commerdel �Private Sewer <br /> ❑Qlher.(apedfy) �Mul�ple Fam�y J Condo ❑Warehouse <br /> ❑PubIIC ❑Storage ❑Publlc Waier , <br /> ••My�rth movament may also requlre ❑Commercial ❑Oth�(specify) <br /> MCWD review 8 permlts. ❑Irsdueitial �Pdvate We11 <br /> Mlnnehaha(�eek Wate�shed Olebtd{MCVW) ❑pfher.(apec�iy) , <br /> 192a2 Minnetonka Blvd <br /> Qeephaven,MN 55581 <br /> Phorte: 962-475-0860 <br /> Fax 952-471-088Z <br /> � . EsUmated Constn�ctlon Valua�on(excluding landy $ a D / �, DZ� <br />