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, <br /> City of Orono <br /> Buiiding Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: /S" � �(�� <br /> �'�Q� PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: S—� <br /> IStreet Address:' Received by: /�.�'� <br /> y ,�/ 2750 Kelley Parkway � Plan review fee: / 7 <br /> �" �� Orono, MN 55356 ' <br /> `qkE5H0�� Main: 952-249-4600 C�( -d(OOC) <br /> Fax: 952-249-4616 www.ci.orono.mn.us �' �5��`��5�/$ <br /> This application form must be completed in full and all required information must be submitted. �x� t- <br /> Incomplete applications will be returned. (P/ease print) Si� <br /> GENERAL INFORMATION: �� Gj� K,�I U r��y' <br /> Job Site Address: 559 Park Lane, Long Lake, MN 55356 � J <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a specra!event permit is requrred with Police Department and Ciry Counci!approval 60 days prior to the event. Shutlle bus service will 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: Atlas Homes Inc <br /> State License# BC269686 Expiration Date: � J <br /> Phone: _(cell)763.691.4099 (office) 763 425 3333 <br /> Mailing Address: 7082 East Fish Lake Rd c�t :Ma le Grove z�P: MN <br /> Contact Person: Mark Way Applicant is: Contractor / Homeowner (ClrcleOne) <br /> Emaii andior Fax: mark(c�atlashomesmn.com <br /> PROPERTY OWNER INFORMATION: <br /> tvame: Timoth� & Joan O'Donnell <br /> Phone(day): Joan- 309.361.9302 Tim 309.361.6695 <br /> Address: PO Box 632 City: Osseo ZfP: 55356 <br /> Email and/or Fax odonnell.t.m(a�qmail.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> Ff�A ICf`T IwICtS�f1AATInRf• f'`acrrinfinn nf nrniort• <br /> � 4. Sewage Disposal& <br /> � �i /� �v• �i ►���� �� // �y�. �' Gara e Water SuPP�Y <br /> � g <br /> j � Public Sewer <br /> � �,f 5 ) � • �(�% ,I <br /> ; � NeW �}ar �v� �`� f ❑ Private Sewer <br /> f� ' <br /> � <br /> ❑ Public Water <br /> ���� <br /> r _ -�-�,,, <br /> n . �� � Private Well <br /> 1 p�ecl �� ��tr�► �v. ' <br /> � D'� ��.�� <br /> F <br /> � � �.� � �.� — <br /> E . �s 8 - � <br /> TT �� <br /> ^ o � fj�� r �c� � " <br /> �`' �' <br /> � <br /> � <br /> .�--___ _ <br />