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<br /> ��` C�ty of 4rono
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<br /> J� � �N. Bu�ld�ng Perrr��t Appticat�on
<br /> � � � for tdew Structures or Additions
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<br /> � vy'� ��►�' ��Ho���. � Perm�number. �.OI lo — Dp,3 S J
<br /> �� Q Cry�ta�eey,MN 553�3-0�6 �`�p . oate r�ehred: �--�—I�
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<br /> S�tAttdress:' Lli�' Receivetf by: C�
<br /> �� �'�',� cx� aOrono,MN 55358 y rJ` Plan ret�tee: Ce�t�' �,f Pf�P
<br /> � - lio � Aqain: 952-24�48QQ T �
<br /> otal Fe�: SCY �-
<br /> E Fax: 952-24�4616 . . s
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<br /> GEWERAl.INF�RtNA'riOM:
<br /> Job l�ite Aaidress: �t 5 N. $l�ore. ,-
<br /> Wlll this�a Parsde of Homes, R+�mc�del�rs Sho�se Home or other L7�ptay Homg7 Yes �No
<br /> �rr�.e�er�,r���ur�a,��oe�+��c�y c�a�►����r��e� s�ru�+�s�wr�r�e
<br /> ►�a�u,�s���s su�ae�per�r���snar�e. n��r,-�er��,as�r�n�an�ea.
<br /> CONTRAGTOR!APRLlCAfi�T�1F�RMA .
<br /> Name: Af��so�s ��o,l ��� C�r»�� u
<br /> S�te Lic�nse# _�c. �7 v o f� Exp�iratbn Dr�#e:
<br /> Phone: c�i! offk� �2 7 3 G 3 3�a�
<br /> tit�[fitag Addr�s: �� + ve, C . �� ;� ZIP: �S 3
<br /> C.ont��t P�rson: t' AppI1t�M is: cu ! Hom�w►ner �u�a o�,�
<br /> �maN andlar Fax: m, t o
<br /> RROPER'T�f QWNER WFOR�ATIGN:
<br /> ��,e: ��� wQ�d�Gh
<br /> �r,,a��a��: �., x
<br /> Add�ess: � ,� � . a�»� ziP: ss 3r� °
<br /> Emai!andl�Fa�c � `o e n-e ,
<br /> AlZCHITEGT/EMGtNEER INFQRMA'i'ION:
<br /> Name:
<br /> Phane{day}:
<br /> ��: _ ZIP•
<br /> Emafl and/or Fax:
<br /> � Me�+ 2�X I t �$- 2� ��3 ec w ,c6cQ } ssca,ts
<br /> PRQJECT INFORRMI�TION: D�cri tiort of �t: �+o � �c�. a��►� ��clG e ��rs f+�+ aaRt� �ik,
<br /> 1.T'y�of�t 2.Prop�ed U�e �. �Ty� __ �.�� �
<br /> g�N+t�v Con�n • �Sir�le Femily vvt� Wab�r Supply
<br /> p Addi�an ���9� � ry Bhdg./Gerag� ❑PubE�S�r
<br /> QA�n��9 ❑ 8ingl�Famlfy v� �t3f��elCammerc�al
<br /> N��+ d � ��c,c.,��+ ��� ❑Reaiden� ❑Pri�t�S�arer
<br /> C��':(�+�. � ❑r�Auitlpie�empy I Condo ❑Ret�ining 1�+�(�)
<br /> � Pu64E� 4-f+�t or g r e a t er Q,Public Water`_
<br /> Any sart�n�9�r�nt m�y�uire Cattm�rt�l ❑Storage
<br /> McwU revie�n►a p�rm�. Ma�ai p war�l,ous� p�dvate weu •
<br /> c,r�c weeers�,�d o�a{a�cv�o) ❑Onaec ts�itY) ❑O�r(�+)
<br /> �s�o�n�ka�,�
<br /> na��mn+�.�wv �as
<br /> P#�ne. 982-0T1-0�
<br /> � 962-471-Q�2
<br /> Estimated Construction Valuation{exduding land) � �3, �ygo
<br /> AwwL��I��a!l�J��d •"_"._�Mie�
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