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�„� ��C r�t�.�� �lc��c.� r r�. �,f <br /> CITY OF ORONO v �_ ����� �$�`'�`" ��� � <br /> BUILDING PERMIT APPLICATION <br /> FO <br /> R NEW STRUCTURES OR ADDITIONS �����`�'�� ��� ������ <br /> O Mailing Address: Permit number: �C.,% � � " �' '/'L �/r <br /> PO Box 66 <br /> � O Crystal Bay, MN 55323-0066 Date received: -z- - 7 -'! �7 <br /> StreetAddress:' R Ceived by: ' <br /> y�, G� 2750 Kelley Parkway �r•� .-QC�f I n revie fee: 36 S� • v� � <br /> lqk�'SH��� Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us � � �� �Z�L� <br /> This application form must be completed in full and all required information must be submitted. U ,q,�q <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: I'1 Sv S �-����,.��o n Rq . , OQoNo � N 5�36�f <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 0 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: S'1'�n��won,p���L __ <br /> State License# (� S9 4 3 1 S Expiration Date: <br /> Phone: (celi) (office) ��1-- ���.-y oop <br /> Mailing Address: 1 F �r �w, Cit : c�.� r ziP: qr <br /> Contact Person: 'ro M w-¢- 7v►vES Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: -� ►u�,�.Q, S-ro c��wao,o co�•u <br /> PROPERTY OWNER INFORMATION: <br /> Name: GR�Tc-�-t�,►J �Nn L-Y�rZ .S FhR-i.� <br /> Phone (day): (6��2� 3 �—81.7 O _ <br /> Address: "700 � JctN65� I�2rvE� C�tY� �O.�l(/ (�.1}iR���P� ST3�6 <br /> Email and/or Fax G�-�,�v�,sl+a_.u.�Q�rc,�,rs�w�-;nr,� cv-n-i Lu/c,s��..w m ow�.�'s�b�. - �n c..•c�w� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: A�r=..x,q-No��- I���z.�� �'an�.� <br /> Phone (day): y�� - �F�3 - 977'7 <br /> Address: o ST tz/o Cit : fi�y�,a- ZIP: �5�� <br /> Email and/or Fax: r1 �nx�.� e ; r . � <br /> PROJECT INFORMATION: Descri tion of ro�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 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) ❑ 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) $ Q�� , Or� C� . C� <br /> Last Updated: January 2016 <br />