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CITY OF C�RONO �� <br /> BUILDING PERMIT APPLICATION �� n��' <br /> � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: �(j/ 7-��� � <br /> � `V , PO Box 66 <br /> � l',,.; ,,%� <br /> ,/r��- � Crystal Bay, MN 55323-0066 Date received: d —/ 7 �� � <br /> '�'�� I�`�� � Received by: ��� <br /> Street Address:� <br /> ��, G� 2750 Kelley Parkway Pian review fee: � ��P`5Z <br /> lqkf S H��� Orono, MN 55356 �/���7�Lf�/ <br /> Main: 952-249-4600 Total 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: , ,,,,,,,r,:,, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shutt/e bus service wil/be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: r�: �����,�J���h��;�i�:�a��„ . <br /> State License# ec�y�sas Expiration Date: <br /> Phone: (cell) s�2.��s.zs2� (office) <br /> Malllftg�1dd�@SS: 12800 Whitewater Drive,Suite?_0 Cjty: Minneionk�:� Z�P: .�:;;,-�3 <br /> COntBCt P@t'S011: Kevin Cummins Applicant is: Contractor / Homeowner �c�.��.o�e> <br /> EfT181�8t1C��01'FaX: kcummins��dwhcme�-ccro <br /> PROPERTY OWNER INFORMATION: <br /> Name: •�a�rr���S,zG��,vt� <br /> PllOtl@�CIBy�: Melissa Johnson 612.4u2.693� <br /> Addt'ess: *same as Abo�e* City: ZIP: <br /> Email and/or Fax mjohnson@dwhomes.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: M�,ine�n&K���F <br /> Phone(day): Zis.6a�.sooi <br /> AC�C�f@SS: 20 Socth(�{;�ple St�eet Sui.c�1�0 �ilt�/: Arribler,r� Z�P: 19002 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck 0 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 require ❑ Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (speCify) ❑ Othel'(SpeCify) <br /> 15320 Minnetonka Blvd �i n tS}� (�t�.�,,,,�� <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �;o,000 f�ECEIVED <br /> UCT 1 �7 ZU1I <br /> Last Updated: January 2016 <br /> �ITY OF ORONO <br />