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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A T MailiPO Bo�r66� Permit number: Q 7-�� 7 <br /> !v� <br /> Crystal Bay, MN 55323-0066 � /) Date received: / -Q/� <br /> � � <br /> StreetAddress:' � Received by: <br /> ti�, G� 2750 Kelley Parkway ,D' Plan review fee: <br /> CqkfSHO�� Orono, MN 55356 � <br /> Main: 952-249-4600 Total Fee: /� D� <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. (P/ease print) <br /> GENERAL INFORMATION: 2 �r /�, ��� � . <br /> Job Site Address: �J'� � �S— �,3 �� �(�3 7 �j�j�SpC�2� � �"�� <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 Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: �-^ <br /> Name: ��VanC,er.� (.CJr�� �*"ru-��'►ar�� , 1.r�• <br /> State License# � /�d�- Expiration Date: <br /> Phone: cell I Z "3; ` - office �L��/�j-7 3�� <br /> Mailing Address: �6�o -r- . f �.a.,..�, Cit : �-� ZIP: �' <br /> Contact Person: �� N 1 Applicant is: ontrac / Homeowner �c�►cie one� <br /> Email and/or Fax: �" c��, . �w.r '�J <br /> PROPERTY OWNER INFORMATION: <br /> Name: k c;P�< s.�! �f�� <br /> Phone(day): 1pl Z-�o�� S 3�15� ��'� <br /> Address: �-y-- Ld w��r� City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGIN ER INFORMATION: <br /> Name: �IVi� �`'S��r� ���. <br /> Phone(day): �2 � ' J� � c i <br /> Address: ^��,�,,w.s,�_�i-,� City: ZIP: <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& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation ,L� • �,f �� detached garage ❑ Residence ❑ Private Sewer <br /> �Other: (specify) �P.1-�.��lr' ���� ❑ 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 8�permits. ❑ 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: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��j U�� ' I`��LE��/�d <br /> �'�i``� � ..� ���� <br /> Last Updated: January 2016 CITY OF OROt�Q <br />