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4_,4 22 906 <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION I, 3 JCS• 13 <br /> FOR NEW STRUCTURES OR ADDITIONS �n <br /> ( OAto RECEIVE /Jailing Address: Permit number: c 1 CO— 0 I ? 7J <br /> POBox66 <br /> SEP 2 9 2016 Crystal Bay, MN 55323-MEW, ' q Date received: 9'—�q—4 CO <br /> Street Address:' ` �' ( ' <br /> Received by: ,•l-r- <br /> yF CITY OF ORONO 2750 Kelley Parkwa r7 <br /> Plan review fee: �� <br /> �txFsti�4�G Orono, MN 55356 -,-/ii : / b— 0 j 1 <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. (Please print) <br /> GENERAL INFORMATIO . 1Job Site Address: ) ) - / C�' <br /> Will this be a Parade of omen, Remodelers Showc--e Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and C '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 INFORMATIV2 <br /> Name: (2o14 1I4l e1- C;, A -� C,_______ )--c-'1 Q--_ <br /> State License# Expiration Date: <br /> Phone: Jcell) 6.'/1 —70 i-ti, (office) <br /> Mailing Address: p 6.-) .;1v 5 City: 4_,‘, -.244; ZIP: 5-5s' c <br /> Contact Person: 0.,,(e_ (f _ r �/, _ Applic "s: Contractor / Homeowner (Circle one) <br /> Email and/or Fax: f'p,t..,,_ ,,, , ,+4. / -�,, _ /, s, , �-� 11:c°c,,, 1.__ „Co�.y <br /> PROPERTY OWNER INFORMATION:� <br /> Name: c/Z5 /OW v9 0- Aj--`-p <br /> Phone (day): 41 . —706'--cod- , --.,-- <br /> Address: <br /> Address: Glc 5175` City: �• G -� ZIP: 5.> 5 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFOR ATION _ 10 C� <br /> Name: '�-� %J ��.�' •,,,_ ��Z — Zk— l ,O <br /> Phone (day): /'i�J( (.4).2-.1 ...,. -fj <br /> Address: f.S 4- ei7�= V fl : Cf ZIP: <br /> Email and/or Fax: <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 ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck dg.Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation / detached garage ❑ Residence El Sewer <br /> ❑ Other: (specify) t.,�l ' G'Cil ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ■ Public 4-feet or greaterublic Water <br /> **Any earthovement may also require VI -ommercial ❑ Storage <br /> MCWD revie &permits. ❑ Industrial ElWarehouse ❑ Private Well <br /> Minnehaha Cree Watershed District(MCWD) (specify) -N-Ether(specify) <br /> ( ) ❑ Other: <br /> 15320 Minnetonka Blvd ®-P4)/C- <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.og <br /> Estimated Construction Valuation (excluding land) $ ' - . : . 7G <br />