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V' �SC� rC�i..L� ���`1�.�r►�tkt"c� a��t� <br /> �� ' , C i'vt c�-y C C�(,��'t����� <br /> ��� I.41'� �=,C2zv <br /> � �� �� <br /> �,�. CITY OF ORONO � <br /> BUILDING PERMIT APPLICATION � . 3 f,���_�� <br /> F O R N E W S T R U C T U R E S O R A D D I T I O N S ,,�,,,�:, ;• � . <br /> �J � Mailin Address: � - �� �=� <br /> /�O p,O � 9 Permit number: ��,� �- �i r...,� <br /> 1 V � PO Box 66 _ <br /> �J Crystal Bay, MN 55323-0066 Date received: �-- > -( -1 <br /> �, , � ,\� SfreetAddress:' _..._—__ -_.__-- -. Received by; _ � G�'��,_ � <br /> ��, G� �� 2750 Kelley Parkw y . �i � '(J��? Plan review fee: • �' � � � '` <br /> �.qkEs�o��, � Orono, MN 55356 � ~ <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <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) <br /> GENERAL INFORMATION: <br /> Job Site Address: =-����; ,�.�rlEt' �� �, <br /> Will this be a Parade of Homes, Remodeters Showcase Home or other Display Home? ❑ Yes ❑ No <br /> /f yes,a special 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 su(ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPSLICANT INFORMAT N: <br /> Name: �i � -�R � - <br /> State License# 3� �� Expiration Date: �j"��- ( <br /> �=��=-z-? �"t- � <br /> Phone: cell y�" • :• office <br /> Mailing Address: _•L �- � ��" � Cit : � ZIP: '" <br /> Contact Persorr: -� Applicant is: ontra�tor-�/ Homeowner �c��ae one� <br /> Email and/or Fax: - <br /> PROPERTY OWNER INFORMATION: i ' <br /> Name: �"tl� ��. �� �lR.._`"r' �I�J�..���� <br /> Phone (day): 'jj,-� -c��,�f?�a}� <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION j � <br /> Name: � ����La� �� (�, �S(��� E Lt.-C� <br /> Phone (day): '7[�;=�.—_ "7`C,�r�C`,�f� <br /> Address: Cit : ZIP: <br /> Email and/or Fax: J,_��. ,_ � �'����� c.�(� c��,�' <br /> PROJECT INFORMATION: Description of pro�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 �esidence j$(Private Sewer <br /> ❑ Other. (specify) �Mlr�t'..{,� ❑ Multiple Family/Condo LI 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) ❑OthOr: (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) $ (, 1`7 �--. <br /> Last Updated: January 2016 <br />