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! � , <br /> ' CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: � , - �,���`� � <br /> ���0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �1 1 1 I <br /> �, ,� Streef Address:' <br /> Received by: I�� <br /> yF G� 2750 Kelley Parkway - �:((,r ' t,c1�=j� Plan review fee: �' <br /> lqkf5H0�� Orono, MN 55356 ' - `l - <br /> Main: 952-249-4600 Total Fee: � ,�' � <br /> Fax: 952-249-4616 www.ci.orono.mn.us �� �G'�� •9 <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) �'1'��j ��g�/� <br /> GENERAL INFORMATION: <br /> Job Site Address: �j?j�j ��„t���� ��2►�E <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.�rz.�So-.r- L ����tit, /v�. <br /> State License# - - — Expiration Date: <br /> Phone: (cell) �S(. ?,0 3 • ��t 2 (office) l�'; • t�38'. 9� <br /> Mailing Address: L�vS �arr�� Q. Cit : ��. • Y= ZIP: SS: i3 <br /> Contact Person: "a r��j S?{,or..-t p Applicant is: on ractQt / Homeowner (Circle One) <br /> Email and/or Fax: �-YL^:, n� �;,`L,a.�e.����,��.a�•„r�.. ci:•.-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ._.�,.,� ;c..lL :..=5r..a �� ��G�U�-ti�-.� _ [.. c.c: <br /> Phone(day): �S'2 . � j �' , L(�9(p T <br /> Address: �-�l/� !,✓. SO"' �nc�ti- City: g�ti�A ZIP: F'js�-{G�f <br /> Email and/or Fax -_;�.J t �-�2,. 1���--�LF}{t • Cc r-i <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: S H c:� A rz.t.,+-t rr�-i� <br /> Phone (day): s�,� "L • ?�3� - j ZS� <br /> Address: �D Sw.�T�-f 8"{ �ra�.r�.r_� City:!✓1�,,,��.a ao�...� ZIP: �'�'-,,'�-/� "L <br /> Email and/or Fax: �,�aso ni S� STt EA'�¢s�r�- Go�`-'1 <br /> PROJECT INFORMATION: Descri tion of ro�ect: ��'���/�1 �� � �'�� <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 /> $ � . <br /> Estimated Construction Valuation (excluding land) �I GG, G�• <br /> Last Updated: January 2016 <br />