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` ,��5.�9,� 51 <br /> CITY OF ORONO i <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �--��;"� Mailing Address: Permit number: Q� ` � <br /> f iV� PO Box 66 <br /> f ` Cr ystal Ba y, MN 55323-0066 Date received: �/ <br /> ( 1 Received by: q�— — <br /> � �, �f Street Address:' G <br /> �''+`2 �f 2750 Kelley Parkway Plan review fee: � � Q • % <br /> \� li . <br /> �t,� ti Orono, MN 55356 d�� �,��� ,� <br /> �kF���,� <br /> _ Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 tnr�nrw ci orana mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ', S�S ✓l'`���� ���� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes f�No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��4 S }-�o�...c_S �i,.�� <br /> State License# �G Z�n(�� 4� Expiration Date: v y / �� <br /> Phone: cell �,2 �ti � �o��� office ��> ti 2 S � � 3 3 <br /> Mailing Address: �t�~c, i� �� ✓ti.. 'U Cit : +�_ ZIP: S� � c�`1 <br /> Contact Person: N(,,,� i,��,�! Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: �:�,�,� �, �� }-�ay L,�v,��,y ,n,l,•�, _ c o�v� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ✓�'�ti��` �14�-c._ �� / . <br /> Phone (day): c�e� i Zg Z. ---��s 5 3 <br /> Address: �c,� a5'� ,�.�,` � City:�-�-�� ZIP: $(Q3p'3 <br /> Email and/or Fax l�,�,�;S,�� lCa�.a..'�` o A�..: L• �—^ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: j�l�� ( ,n � <br /> Phone (day): y c ? 3��; �+3 7�� -, <br /> Address: �� �;�y���-',\ 4,- City: �`>S�U ZIP: L;�� >F�`� <br /> Email and/or Fax: _r,}a a��(�,,, v !>� . � c�� <br /> PROJECT INFORMATION: Description of pro�ect: <br /> � �yna nf P�ninr♦ � �"'-"'-�d Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> /�� �' � � amily with 8 Residence <br /> �d garage ❑Garage/Accessory Bldg. �Pubtic Sewer <br /> / O �D. � � =amily with ❑ Deck <br /> ed garage ❑Office/Commercial ❑ Private Sewer <br /> Family/Condo ❑Warehouse <br /> � ❑ Storage ❑ Public Water <br /> , � rcial ❑ Other(specify) <br /> al 0 Private Well <br /> �pecify) <br /> $ L � I � UOU : (>� <br /> � � � 7 75. �� <br /> � <br />