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09/30/2010 THU 8� 41 FA� 507 665 3775 6edvex Co�p�ny �002/003
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<br /> ing Perrnit Application
<br /> for New Structures or Additions
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<br /> Crystal C�ay, MN 5G323-OOGO �ate received: �.'Jd�! �
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<br /> '9'� - ' �p, G�`� 2%30 Kc�lloy Parkway I�I�n rovi�w fae;
<br /> `�'?�c � o4s,"-.::/ Orono, MN SG3fi6 •
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<br /> �,._, Mt�in: 95�-Za9�.dfi0� '� �eX: 9�2•�;Zk9-A616 www.ci.�rono,mn,us '
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<br /> '1"n)s application fnrrn must be completed in full and all required information must be suhmitted,
<br /> incomplete applications will bo roturned. (/�lease pr�i��f)
<br /> GENERAL IN�ORMATION:
<br /> Job Site Address: lA� ?���� �
<br /> Will this be a Parad� of llomes, Remddelers Showc�se Home������������ � � '���T���� �I—+��
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<br /> or other Dis la Mome7 ` � Yes ��o
<br /> I(yoF, a spc cial�vanf�c�nT�it is�c,purrr�d with Pollr.e nopc,rtmont nnd C,Iry Gvunc!/npprOVAI 60 dHys prio�royne,�vu���. �auui@ ,�IJS S(1�1/ICA WIII I)O
<br /> reyufrntl u/IIOss appHr.�nl demonsir�(cas sulficio�if un-slle ptirkin�is nv�llal�le, Non-por•miflocl c�vc�nfs wiU not b�nllnwod.
<br /> CONTRACTOR/APPLICAN7 INFORMATION:
<br /> Name: �Y� '��G�,�Y'v��l..C.._�.
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<br /> Mai(ing Address; 12�..�__ --- � CiC.... . _ V- .._ZII''; ... .____,:,,. _
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<br /> Contacl Pc:rson: 1 A licant is; Contractor / i-lomeowner �Girclu one)
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<br /> kmail and/ar Fax: 1/.C�1.1m1�.�..Q� ly, yC�J � ��vYY'�
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<br /> PROP�RTY OWNER�IN,F�F�MATI�N:
<br /> N�me: `
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<br /> Pl,one (day);
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<br /> C-inaii and/or Fax � "��- --"'�� "C"'�'"''�� --��� �
<br /> ARcHiTECT i ErvGINEER INFORMATION:
<br /> Nam�:
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<br /> Phono (day); -�............. .
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<br /> Address; City: ,ZiP:
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<br /> Email antl/nr Fax; .
<br /> PROJECT INFQRMATION:
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<br /> 1,7ypC of Proj�Ct' 2. Proposad�Use 3.Structurc 7ypv 4, Sowage Dlsposal&
<br /> Wa�r Supply
<br /> [] N�w Construction ❑ Single f=�mily wifn .�R�sidenc;e
<br /> ❑ Addltfon atCachod c�arage �� G�rag�/Accessory 81dg, � hublic Sewer
<br /> ❑ACcescory Buildinc� ❑ 5ingle FSmily with r (�pck
<br /> ❑ re�ocation �/� detached gar�,flc� �Officc/Commc:rcial ❑ Priv��te Sower
<br /> � Othor; (spectfy) i� �O��OY�� c:(.,�.�. Multipfc, 1=amily/Condo ❑Wareli�uhc
<br /> �.,,,J f-'ublic �;„;� Siora�a �] Public Water
<br /> ""Any earth movamEnt may requlrc �] Lornmercl�l �„] onc��r(sneciry)
<br /> MCWD review 8 p�rmits. ❑ Industriral ❑ I'riv�a�a W011
<br /> Minnehoha Crc��k Wat�rypied Dlstrict(MCWD1 � her: (�:p�cify) �V� '
<br /> 102Q2 Minnolonka R)vd ,p �(;�,��
<br /> Ucephavcarl, MN 553�1 –{y'1� " ,"-"'....`
<br /> Pl�on?; 952•4'%1-OG90
<br /> rax: ��z-a7�-o�oz
<br /> www.minnc�hAh�cre�k.orc{_
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<br /> Cstimated Cc�nstruction Valuation (c�xcluding land) $ �J'/ v '��.,.^.:,,4,
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<br /> 4ast Updated: 9/29/:.�UU9
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