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'� • �� <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRl1CTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: � �/ � � �-C]� � <br /> O PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: � /� - ��r_ <br /> —,-- <br /> � Received by: _...._. -%� <br /> ` a ,, Street Address:' -- <br /> ��%F v 2750 Kelley Parkway Plan review fee:�� ' � ' j <br /> \��4kfsiio�`` Orono, MN 55356 ���.__ ' <br /> �.;. Main: 952-249-4600 / <br /> -- __ __ <br /> __--- <br /> --� Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us �(�;� t � �� <br /> This application form must be completed in full and all required information must be submitted. ,,� 1 <br /> Incomplete applications will be returned. (Please print) � �� �J � �I <br /> GENERAL INFORMATION: 3"��'�- # ��� <br /> Job Site Address: �re.s�wo�-�_��Sines3 �-n'�C �.Sad J�o�d woo� �, . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 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: --�c�rQ.�__�p98 L.L,C . - --- <br /> State License# _ __ __ Expiration Date: _ _ <br /> Phone: (cell) �ia -_3�3 - 33a� (office) <br /> MailingAddress: y/o // '` Aue. S,• Cit : k;,,s __ ZIP: ,fS3`l3 <br /> Contact Person: A 1 ex Q. Applicant is: Contract r / Homeowner (Circle One) <br /> Email and/or Fax: o,.\e.X J f►�,dland.G�a�,cor� . __ _ <br /> I <br /> PROPERTY OWNER INFORMATION: <br /> Name: O L.�..�'-. <br /> Phone (day): (o -3� -- 3�1 <br /> Address: y Io �1°` �Hue. Sd- City: F-�oa k,ni ZIP: ,SS3y 3 <br /> Email and/or Fax ��e x ��;��p�a. 4la.sS. �or� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: (�-�� �ku s �c���ke�atS <br /> Phone (day): q$d - 9�i ( - ��p <br /> Address: /$ Nin�l. A�o. IUo, City: {-�p�k��s ZIP: �53�}�_ <br /> Email and/or Fax: d� p � W; ��«, Qr� , cor� _ _ <br /> � <br /> ��„�,� �;iz � �' � i:t% <br /> PROJECT INFORMATION: Description of project: � <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 � Public Sewer <br /> ❑Accessory Building ❑ Single Family with � Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> � Other: (specify) �a(+')m�.� ❑ 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 /> � <br /> Estimated Construction Valuation (excluding land) S �pd <br /> Last Updated: January 2016 <br />