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� CITY OF ORONO � <br /> BUILDING PERMIT APPLICATION � ��-� ,/-�-� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O MailingAddress: Permit number: OI� UOII� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 43 — —��' <br /> StreetAddress:' Received by: C <br /> y�, G� 2750 Kelley Parkway Plan review fee: � � �,�� <br /> C�kESH��� Orono, MN 55356 ���8-ao��g ►� •� <br /> Main: 952-249-4600 To Fee: -l4'w <br /> Fax: 952-249-4616 www.ci.orono.mn.us s �.-�� ���������� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: - <br /> Job Site Address: (p�jO �r7e�i�rsf" Ccvr'f— <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> /f yes, a special event permit is required with Po/ice Department and City Counci/approva/60 days prior to the event. Shutt/e bus service wi/l be <br /> required un/ess applicant demonstrates sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> N ame: pr-/ri� (�L <br /> State License# (� Expiration Date: 3/ l <br /> Phone: (cell)(�/ (o•7(o(o (office) !�3•SS7� <br /> Mailing Address: � ( hJ � Cit : ZIP: <br /> Contact Person: (' t.�s r y� Applicant is: ontrac or Homeowner (Circle One) <br /> Email and/or Fax: C riSh���-/7�,--, hdrn�S_ ��� °�rc�, wna l�vriz�-i�nP,� . c�.s-r, <br /> PROPERTY OWNER INFORMATION: <br /> Name: �GVrLL (�nd QP.IJP.�G��'>'?-e�� <br /> Phone (day): �J(p3-Ss� `d/ OU <br /> Address: !$'a-/f �fSt�— ,�� N S'a-�_ /'� City: �y/r:r.�/�fi ZIP: S��(o <br /> Email and/or Fax �k/� ,�jiq-���,-,L( �cy,,.�_ <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: D F P Plas�r�i.�� �� G��S'i.o�r� <br /> Phone (day): 7l03 78"b $�06�'Y, p .- <br /> Address: _�-}(pD �.narLgl-NC c�+C. {p�,, City: Of2fh� ZIP:��y�-�' _ <br /> Email and/or Fax: �,� d '.(����,c� <br /> PROJECT INFORMATION: Description of project: /V�G�U r�es�dc�.h� �d'�'y�.e,-� <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> �ew Construction �Single Family with ❑Accessory Bldg./Garage <br /> ddition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage �esidence �Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (specify) ❑ Othef(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or R <br /> Estimated Construction Valuation (excluding land) � �SO 600 F��� �ntQ <br /> CIN OF ORONO <br /> Last Updated: January 2016 <br />