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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION , <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> "0 A) Mailing Address: Permit number: c .0 1 V -C I 37 , <br /> tiWPO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 1 012-8 l i (G <br /> StreetAddress:' — Received by: <br /> � Oron Kelley Parkway O ( - � Plan r viewfee: , r : •K�sHo4Orono, MN 55356 1 (=f� <br /> Main: 952-249-4600 To al Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us 7‘/V. <br /> ri <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) y v,<, . <br /> GENERAL INFORMATION: � : <br /> Job Site Address: 1�2 .S f;, �jt ,1-� <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/APPLICANTt� INFORMATION: <br /> Name: QV:T&._ Ec ..e2 <br /> State License# fie—CeS3 `i5-3,/ 0 Expiration Date: 5/3(4$' <br /> Phone: (cell) 7(a S-2 -- 2-(29 (office) ` S 2-9 ..(DS1 x•)( <br /> Mailing Address: 2311Ter.-1" City: Lo L„,-, ZIP: .SS 3.5to <br /> Contact Person: AS • '-e Applicant is: ontrac )/ Homeowner (Circle One) <br /> Email and/or Fax: k is -c .164 testy <br /> ._ w,,.` <br /> PROPERTY OWNER INFORMATION: � � <br /> Name: ncr' 4 - ; 'TJ--Phone(day): '7 "2- 22/ 'r2 <br /> Address: ►\25 ;.-cv, S �:v City: Oce ZIP: SS `L, <br /> Email and/or Fax rty,s_( exp.,,;1.ce,"--. <br /> ARCHITECT/ ENGI=INFORMATION: <br /> Name: L.G32 <br /> Phone (day): cls 2--a -C 7---9`i 7 7-- <br /> Address: °`ZD-(c btAn;z� -- City: (...or, ZIP: sc i , <br /> Email and/or Fax: yta4z E?0,.„ r.e._ tct(►eS.c� <br /> PROJECT INFORMATION: Description of project: Po© I H OU Se. (pe-0 <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction 0 Single Family with :_- .. : /Garage <br /> ❑Addition attached garage ❑ Deck 0 Public Sewer <br /> ,Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 0 Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo 0 Retaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ErOGh�er: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd t Alcr <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ �0 <br /> Last Updated: January 2016 <br />