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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �� <br /> O�T PO Box 66 <br /> 1 VO Crystal Bay, MN 55 23-0066 Date received: <br /> Street Address:' Ok—vim. Received by: <br /> 2750 yKelley Parkway F 26 Plan review feq <br /> tq <br /> Orono, MN 55356 I7Q'\' �' <br /> fSHo�� 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: )-3 SO m)! 515-35-6 <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: Si rph*n 6f p­ <br /> State License# — App"s- Du.,"-fr Expiration Date: <br /> Phone: cell 6 I)- a46 S6 J-Y office <br /> Mailing Address: s d G c% City: 'k-w o /n.1v ZIP s' 3 16 <br /> Contact Person: v-c, Gav,, Applicant is: Contractor / omeow (Circle One) <br /> Email and/or Fax: a 0& I tr-e .Gr✓r+^ <br /> PROPERTY OWNER INFORMATION: <br /> Name: Sbmz G*V<- <br /> Phone (day): <br /> Address: 0� W e rwr City: d�yyYa ZIP: SS 356 <br /> Email and/or Fax 5 AS N- (�' a�u>ti-�„I(, �r•,an , corm <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ENGINEER INFORMATION: 111110111"D <br /> Name: <br /> Phone(day): Fre 13 2018 <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> CITY OF ORONO <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ElSingle Family with ElAccessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ,Public Sewer <br /> ❑Accessory Building Single Family with ❑ Office/Commercial <br /> ❑ RelocationL�/I detached garage esidence El Septic <br /> Other: (specify) i1! "n -em Ad'4 ❑ Multiple Family/Condo Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> "Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse <br /> ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ,Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.m innehahacreek.oro <br /> Estimated Construction Valuation (excluding land) $ J <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />