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� Tc�ral Fee: $ � -J � ' `� � / <br /> Dabe Received: <br /> ` ' P.nreretl HY� �'°--<J P�mit A�: ' =,r, �7 7 � . <br /> , � <br /> ;�5. � ��%" . i� . . <br /> . �ITY O� ORO1�T0 - BI]I�,DING PERMYT APPI�ICA7'xON <br /> � A� infot'inadon must be su�nitted ln tY�U befaee plan review wiU 6e atarted. <br /> � •, � �p�ease pHnt all�forn�acion). . <br /> � NW�7���������1^w rrr��w�M�MI`^���1�^�IY��rr��r�a�N����������� br/I������..w�w�...��w����� <br /> THE APPL'ICANT IS: (Cttcle nne) �O�VNfiR OR TRACTOR <br /> • . . , <br /> � �►o� sY�Ann�ss: �a� tv • i�c,n, ��x;� zri�: �� 3(�y A�'.`- � <br /> �, --.--- . <br /> �: N�o�ow�x: �:hnT�� l�.�c.c�,- �xor�: c,�)9s��y a• (�9� 1 <br /> (work) <br /> MAILIlVG ADDRE&S: .L�'1 CI'I`Y: rrc cr�vc'� ZTP: '�' <br /> , • , , � . <br /> . „ . . � . <br /> . . • . <br /> CO1V'1'RA(;T4R. REN�WAI. SY ANbEP.SEN �' - -- � -- <br /> �..CONTACTP�RS4N� 35�-73RD AI�E. Nc �a: <br /> • ' ���G��� � r RTDLEY, MN 55432 ZII": , <br /> �6fiAT� LICEN3�: � ��� t672) �o2-�a77 -'�"'---' <br /> LxCE�SE #2013�983 . � <br /> . ABCHITLC'!Yb'•1�TG.�R: PHONE: <br /> MAILYNG AUD�SB: C�7'Y: � ZtP: .__ , . <br /> � <br /> NAIVi�: REGLSTRATiON� <br /> TYP� OF'PVO�C: New Addition� Acr�ssory Snv�tuce <br /> � 1Viov� Remodel/Alteration�„_ Land Al�eratio4_____,,,, - <br /> PROPOSF.I}�ORK(descrlbeln derail�: ��- 4 ,.�t�4� ���o, ��v����� <br /> � <br /> STOBITS: � SQ.F'��7'OF EACS FLOO�: - � <br /> , I�QO. OF BEDRQOMS: � GARAGE STAL.GS: A7T. DL'C. � <br /> , oG <br /> FSTIMA'1'�D CONSTItUG"MON VALVA'T�QN(excluding laniq: � �,4�0 � __ � <br /> I h�reby epply �or a buildiu�g permit and I ackcwwledge tbat the informetion a6ove is comple�o and <br /> ecc�uate; tbat tbe w�ork will bs in conforroance�with t�e ordinesues and Fod�s�of the City ai� witt► <br /> � .' ttve Stato Hullding Code; triat.�.uaderatand tl� is aot a p�rmit and work is not to 9tart without s . � <br /> . per�t� a�d that tl�s wark wlll be 1n accoxdatice vvlth the approvod plan. � - �� . <br /> AI'P'11CANT'6 StGNA1'[1R�: DA►�s _�• ►����. <br /> � 1NOTE1 ,P,.p�d�/l�en�e.c tvtnts rieqtrfre aepamte petn�a,pprnval by Paldce Depu�teptQnd <br /> Ci� Coruici�60 daya prior%the gveRt. Non perm�Utad eve� wul not be allowed. � <br /> £/Z ' d �°'9� 18 ' oN'° c°" �A � ' '��3S 1fW�3d �N1011�9 S3N0�-�3413� �� WdZZ � OI'i100Z '� ' adH <br />