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. <br /> _ CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �O � Z�� �� <br /> g' �O PO Box 66 I� <br /> Crystal Bay,MN 55323-0066 Date received: <br /> ,, �, Sbeet Address:' Received by �IQ ----� <br /> y�. G. 2750 Kelley Paricway ��-� Plan review fee: -rj � Z • � <br /> ��Kssxo4�' Orono,MN 55356 �� C:� i�'� <br /> Main: 952-249�3600 tal Fee: <br /> Fax: 952-249-4fi16 www.ci.orono.mn.us <br /> This application form must be compteted in fuA and all required infortnation must be submitted. <br /> Incomplete applicatlons will be retumed. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ���p �,N� v�Ew) ]�R. �o�,d <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No <br /> If yes,a spetval event pem+it is required with Poli�e Department and City Council approva160 days prior to the evenL Shutde bus service wifl be <br /> required uNess applicanl demonstrates sullicient on-site parking is avaflable. Nonpermitted eveRts wfU nof be sllowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: S ra,v ►.,oe <br /> State License# � Expiretion Date: 3� Zol a <br /> Phone: (cell) 6�Z Zc� - �j��; (office ' 46].- 4000 <br /> Mailing Address: 1 S 3 L�wf S,. � City: �,�.,�,q.,�,�} ZIP: � � <br /> Contact Person: ��� ,,,�irs w.t-h� Applicant is: Con or / Homeowner �c�rason.� <br /> Email and/or Fax: _ �I�-.-ti /,� �,.�,�,t ��,o o.c.�►.. <br /> PROPERTY OWNER INFORMATION: <br /> Name: _ ��V►i) + f� E�,A�J 1n�0�1 �w� �,D �.vsr 'Te..s,�*(s.�� <br /> Phone(day): <br /> Address: 4'G'16 ���et�k. T� S City: MEDi.�� ZIP: s��o <br /> Emailand/orFax �LI�.�eH�wE'w�� � �r.a,L tur�� �V1£weNLa.��jJ� eGw�A.�� �e� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: I�I�s.►a i�s�ot�nwt. 1���c.r.J 2r�� <br /> Phone(day): �c 3-�bo- S o0 4 <br /> Address: °t lea R�-�„M.e�..tc S�r . wE St� IDG City: atA�n, ZIP' SS449 <br /> Email and/or Fax: "a-�;-�so- Se�f <br /> PROJECT INFORMATION: Descri tion of roect: �G�J <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> �New Construction �Single Family with ❑Acxessory Bldg./Garage Water Supply <br /> Addition attached garage ❑Dedc <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial �public Sewer <br /> ❑ Relocation detached garage ❑Residence <br /> ❑Other.(speay) ❑Multiple Family!Condo ❑Retaining Wall(s) �P�ate Sewer <br /> ❑Public 4feet or greater ❑Public Water <br /> "Any earth moveme�t may also require ❑Commerpal ❑Storage <br /> MCWD review d�permlts. ❑Industrial ❑Warehouse <br /> ❑Private Well <br /> Minnehaha Creek Watershed Disfict(MCWD) ❑Other.(speafy) ❑Other(speafy) <br /> 15320 Minnetonka Blvd <br /> Mfnnetonka,MN bb345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ne r <br /> Estimated Construction Valuation (excluding land) $ �, S3�i � <br /> Last Updeled: January 2016 <br />