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01/07/2009 03:26 7634258859 MPS PAGE 02 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> UaNPO OX as Permit number, DO�I- 600 7/ <br /> Q Crystal Bay,MN 65323-OM Dale received: / O <br /> Shw1Address.' Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> Orono,MN 55356 <br /> Main: 952-249.4Wo Fac 9S2-2494618 www.ci.omno.mn.us I <br /> Total Fee: <br /> This application form must be completed in full and all required Information must be submitted. <br /> Incomplete application will be netaurned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <br /> VWII this be a Parade of Homes, Remade ere Showcase Home or other Display Home? Yes No <br /> !ryes,a*WW evW permit is required with Pallas Dgwrtrnent end My Caundl approval W days pilar to the event ShuEde bus eerviloe wX be <br /> required unites app/Amt donmamos su8fdew on srla powng is et/ai ft No4oamnHed aventa wql nal be ellawad. <br /> CONTRACTOR/AP F ON- <br /> Name: <br /> State License# Expiration Date: - <br /> Phone: - - Lam—pi Call <br /> Mailing Address: h `� C ke P: r6' <br /> Contact Person: tri Applicant is: Co or / Homeowner (ewe oil <br /> Email and/or Fax: , tiAA A- OYA.9 <br /> PROPER' Y OMT <br /> NFORMATION: <br /> Name: a f1 <br /> Phone(day). <br /> Address: L - Ci ZIP: r <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day). <br /> Address: City: ZIP: <br /> Email and/or Fax. <br /> PROJECT INFORMATION: <br /> .Type of Protect Z Proposed ilea 3.Structure Type 4.Samoa Disposal& <br /> New Construction [3Single Family with Roffice/commardal <br /> Residence Welter SuPP1y <br /> Addition aaaahed game Garage/Aeoessori Bldg. ❑Public Sewer <br /> Arxessory Budden Single Family with Deck <br /> Relocation ,�,(A� detached garage ❑Private Sewer <br /> Other(specify) 1tUJ" Multiple Family!Condo [3 Warehouse <br /> Public Storage ❑Public water <br /> "Any earth movement may require ❑Commerdal Other(Spedhr) Private Well <br /> 111t:MID re [Iview&permt�. Industrial <br /> Mlnrr¢fmlre Create watershed Otatrtet(Mcu ml rj Other.(specify) <br /> 152M MkmMarft Ow <br /> Osepnererh,MN 88391 <br /> Phone: W-4714O590 <br /> Feat 99-171.0882 <br /> Estimated Construction Valuation(excluding laril) S DOD. D d <br /> - 16- <br />