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� � <br /> s <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION ,� <br /> FOR NEW STRUCTURES OR ADDITIONS �i �l� �� � <br /> �O� Mailing Address: Permit number: t r� g <br /> O � PO Box 66 <br /> _ ` �,�L Crystal Bay, MN 55323-0066 Date received: ' '-z C'' V 1 � . <br /> �1 ��J Received b � �-- '� <br /> �\$\\� Street Address:' ' O �_---�.-_._____.__-__-_-- <br /> y�. G� �0 � 2750 Kelley Parkway � C����� Plan review fee: i r� � <br /> ��kFSHo�� Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono mn.us _ �c7 � <br /> This application form must be completed in full and all required information must j2e�mitt� �-�x��. <br /> Incomplete applications will be returned. (Please print) 5 p <br /> GENERAL INFORMATION: oZb � fv-o D S b <br /> Job Site Address: ` � � ���-�,��t,.��.� � `i�� ._.G � <br /> �b�J J�J � ��., L': .i� � Ld ��1Ltd.� _ „"e T� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No ,p <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be �(� <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: C� 2 e.5a,t - La�� a E� 1�1 C. <br /> State License# Expiration Date: <br /> Phone: cell -" �, b (Z, office i . �c C;.9�oQ� <br /> Mailing Address: - `��,,.i„ � Cit : rZc. ,r'y�c,� ZIP: �� <br /> Contact Person: �� Applicant is: C�fractoF / Homeowner (Circle One) <br /> Email and/or Fax: �,���.z.��Q'.,,�.,,r,�c E .Cor-t <br /> PROPERTY OWNER INFORMATION: <br /> Name: L..c1�., r� T=-o o.� -,�-��ut� ���-S � ,�:c • <br /> Phone (day): �I SZ• 9l� 2Cv"�'-� <br /> Address: y 1ov InJ, Sp"''"t 57��.er City: ���-�4 ZIP: 'S�i( '2� <br /> Email andbr Fax �2�,ss . cL,�;.��,c�.w�cx-t� L r-a-t� ! . c..D�.-� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: _Sd-f vd �c12.�'-+-t r-7'z�",c.-T� <br /> Phone(day): �,� Z . �'�� . �{Z J"t � <br /> Address: %d So.,� �"` ST. City: .M��N���S ZIP:�S�v � <br /> Email and/or Fax: . � 6 N a� .Srt►....�e.�S r �l .c,Q �-'1 <br /> PROJECT INFORMATION: Descri tion of ro�ect: ���� ��� � L� � "�� �'�- � <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 [�O�ce/Commercial <br /> �Relocation detached garage ❑ Residence ❑ Private Sewer <br /> Other: (specify) � V T�M�- ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ��o�►L [� Public 4-feet or greater Q] 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) $ �'�', �'� � ' <br /> Last Updated: January 2016 <br />