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f e <br /> . s <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> --� <br /> j�Q� Mailing Address: Permit number. p�d Q�,�j� <br /> � � PO Box 66 <br /> �1 O Crystal Bay, MN 55323-0066 Date received: _�/ � / 7 <br /> � . Received by: 7�y1� <br /> `�; ,, Street Address: _ _ � � <br /> �`'� G: 2750 Kelley Parkway ' ����, Plan review fee: v+�/. � �", <br /> ��KE.S�{��� Orono, MN 55356 �� C�1c,r (��t'�-, 7 ; <br /> -- - ...._ ._. _ _�� ��� ... <br /> � Main: 952-249-4600 Total Fee: � y '� <br /> Fax: 952-249-4616 www.ci.orono.mn.us .� ! .+ ��>G�_ <br /> �,- , <br /> This application form must be completed in full and ail required information must be submitted. �y��t� �_h� �� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �. <br /> Job Site Address: ,��'�;v s}�� �k. , � ��. �d j�;��, 11 b� �3a�� �p /.30(} <br /> Will this be a Parade of Homes, Remodelers Show ase Home or other Display Home? ❑ es �No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service hTill 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: ��or.z��_ c;'(� i..L.C- <br /> State License# Expiration Date: <br /> Phone: (cell) �i a- 3�3-3 3:�� (office) <br /> Mailing Address: �I ln 1\'�` A.,� S�; City� �.\�,�k,��� ZIP� �;3y3 <br /> Contact Person: Ai�x �,or�+, Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: �,,,\izx �, e,,;d��t�,s .�,,,., <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: - - U��r�� ��,t�' L,C..,L_ - rl\.a.�c �.1�, -��+ <br /> Phone (day): (�,ia- 3t�;3 - 3 3�a.� <br /> Address: y�v ���►�- A-,,t. S�• City: NG,�k,.,t ZIP: 5�343 <br /> Email and/or Fax _ �\e.x ��_ rr„d1�.,,��4�s� .c�r� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: l.�i�1�.�� �►r �:��� }� <br /> Phone (day): �jS:� - `�'i I - �Ji:- -��� <br /> Address: /S �i.:'n f,� ,.��� , City: f-lopk�nr ZIP� 5'S3�/' <br /> Email and/or Fax: c�I n � w;ik.�<a�r�, cL,,� <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Singie Family with ❑Accessory Bldg.!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) re���� ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ,gf Public Water <br /> "*Any earth movement may also require Commercial ❑ Storage <br /> MCWD review&permits. � Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District MCWD ❑ Private Well <br /> ( ) ❑ 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.orq <br /> Estimated Construction Valuation (excluding land) $ �/z'� i 6�"�`�`-' � �� RECEIVED <br /> JAN � � �Q17 <br /> Last Updated: January 2.016 C�•�.Y��OR�Nd <br />