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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS �� <br /> A, MeNfilg Ad�ess: � <br /> � O Pemdt rwmber. <br /> � �Y PO Box 86 p� � <br /> Cryatal BaY�MN 6532&0088 Date reoelved: O lD'- <br /> y �' �50 �� Reoeived bY. <br /> �. G. <br /> �►P�y �,re�►�: ��'"3/ 88' <br /> ��kESHO��' ���MN 55358 <br /> Total Fee: ���5 <br /> Main: 952-249-4600 Fa�c 952-249-4816 www.a.orono.�.us <br /> This application fonn must be completed in fulf and alt required informa�on musf be submitted. , <br /> Inwmplete aPPlications wfll be retumed. (P/ease pdnt) <br /> GENERAL INFORMATION: <br /> Job 31te Address: o <br /> V1rll this be a Parade of Homes, Remodelers Shov�case Home or other Display Home? Yes No <br /> !/1^es,e speck/e►renf pemr�!s�equ�red w�h PaNroe Deputr�nt�d C�y Couv�l approva!�days pAw to tM s�rent Shuldb bus ss�v�ce w�bs <br /> requ�ed uMess app�ca�demonsbabes sullPds�on-sl�s parl�►q!s av�s. Nan-pemwlted ev�Ma w�not bs aNbwed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> N8�1'1@: ��A2fl<<sPE( <br /> State Ucense# Expiration Date: <br /> Phone: (cel�) 6 �2� 3 6 3- �'T 6 (office) 9 rz 8��-z�s y <br /> MailingAddress: : 'K��,,.�� ZIP: s- 420 <br /> Contact Person: �.,��,, S�t u�, ApplfcaM is: or Homeowner �cxa.o�o� <br /> Email and/or Fax: 1„�,� �, �r A��s n e r,-,,,,� �c�..., <br /> PROPERTY OWNER INFORMATION: i , <br /> Name: � C.�,� <br /> Phone (daY): 6�z- n t <br /> Address: _$�o ,C n r'T G•N l� �� �<� Clty b r��a ZI P• S.�` 9 I <br /> Email and/or Fax C, .d,_ � .... <.�p.� ctn r�r ,c�..., <br /> u __ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �v /A <br /> Phone (day): <br /> Address: City' ZIP� <br /> Emaii artd/or Fax: <br /> PROJECT INFORMATION: Desa�l tlon of ct: <br /> 1.Type ot ProjecE 2 Proposed Use 3.3tructure TYPe 4.8a�wage Disposal b <br /> ❑�� �� �a��ached��e �R��denoe , Water Suppiy <br /> 9�8 ❑�ra9e/Accessory BId9• t�J Pt�lic Sevver <br /> ❑AccessorY B�ding ❑ Sin91e FamNy wnh ❑Dedc <br /> ❑R�ocation 'Dr1 J`w� .�.��, detact�ed e ❑Offloe/Commerdal ❑Private Sew�er <br /> ❑Other.(spedN) a O M�Fa�y/Condo ❑Warehouse <br /> a�� ���W� <br /> �a,y.a�c n mo�eme M�,,,��s o�u�re ❑�o�►�aai �o��8�,, <br /> MCWD rovlow 8 ❑Privvatte VV'ell <br /> Mku�ehahs Creek Wa ersF�ed DisMct(MCWD) 0 p�gr(gpgq{y� e <br /> 18202 Mirr�etordca 81vd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> vwvw. ' creek. <br /> Estimated Construc�on Valuation(exduding land) ; � 3, c�o `— <br />