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. • w '^ , / �� C�-��..1.` � <br /> \ N t� ���'rc c..� �--c�r�e r�¢��� <br /> � <br /> CITY OF ORONO � 9 /9 • 90�/ <br /> BUILDING PERMIT APPLICATION l � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: �� � Z—"(���% �� <br /> �VO PO Box 66 , <br /> Crystal Bay, MN 55323-0066 Date recewed: � � <br /> ,� Street Address:' _--V- Recerved by �� --� <br /> .-- <br /> y�. � 2750 Kelley Parkway � , . �•� �` Plan rewew fee� , . 'r'.� 1 -? . � <br /> ��kEstto�`�'` Orono, MN 55356 ��4���� " .�- '� L 1 `'t 71,;.;� __._ <br /> Main: 952-249-4600 Tbtal Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <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: �����N� �(�F� ��, ��,o <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> h yes,a specia/event pemut is required with Police Department and City Counci!approva/60 days prior to the event. Shuttle bus service wifl be <br /> required unless applicant demonshates suH'rcient on-site parlcing is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 5 ra rrt�.,eo <br /> State License# S � Expiration Date: 3, z o�S <br /> Phone: (cell _ � �Z Zc� - q��� (office ' ¢6 i- 4 000 <br /> Mailing Address: 1 S 3 l,A wE ST, l% City: ���,�.,�,4.r,�} ZIP: SS34 f <br /> Contact Person: ^�� ,,,�,.�,.�-�,. Applicant is� Con�or / Homeowner �circie or,�� <br /> Email and/or Fax: ��-.-� �S,..o,�,t �_..�o.c.�- <br /> PROPERTY OWNER INFORMATION: <br /> Name: _ �1�v►i� t �'i E�,A�I �Ot'�L1V� �D T�-vSf 1 EVST'Et�S�, <br /> Phone(day): <br /> Address: �-S'b6 ��E�Fk, Ta S City: MEDi�+�t ZIP: SS'�q.o <br /> Emailand/orFax �LweH�wE'�.►) � G.�a��•cu� �1£�,..el�lLbvFNC�, Gw.��... �o� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: I�le�soa i�s►otc�a� ����.,.1 , 2N�. <br /> Phone(day): -���-�-�o- g�q- <br /> Address: �teo gq.�„N.en.E ST . tiE 5tF 1OG City: �3��„„E ZIP: SS44't <br /> Email and/or Fax: '�-�3-�sa- $e�s <br /> PROJECT INFORMATION: Descri tion of roect: '� �` -� ,�' �" � -°���` <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> New Construction �Single Family with ❑Accessory Bldg.I Garage <br /> Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑Residence ❑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 requfre ❑Commercial ❑Storage <br /> MCWD review&permlts. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.minnehaha reek.or <br /> Estimated Construction Valuation(excluding land) $ �, 53�� �=� <br /> Last Updated: January 2016 <br />