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e v <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> q, Mailing Address:PO Bx 66 Permit number. <br /> / ��`V�l' Crystal Bay,MN 55323-0066 Date received: <br /> Received by: <br /> Street Address:' <br /> 2750 Kelley Parkway Plan review fee: <br /> ei,(\ `-` Orono,MN 55356 �/7 <br /> {rkj s ii�i���� Total Fee: 47—D( ', 7 <br /> Main: 952-249-4600 Fax: 952-249-4616 <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: AOS ' 5-,t- Ld41/4(e_ c.. Sct / Cftyce MO 553D <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ►: o <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 T 11 be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: i <br /> Name: ti:.r ):; i 51.6" (-it)P°rte, eF' kft4e- iinil <br /> State License# I'3G ; Expiration Date: <br /> Phone: (cell) ,/01- -'If C -lila/ (office) ZIP: <br /> Mailing Address: 61)_.-44... 'ice 0J A.�.1 Ci : _ Vey- iS'35)o <br /> Contact Person: Applicant is: on ra • / Homeowner (circle one) <br /> Email and/or Fax: tr,41G rviv,'o. he tire, . i- /-1 i 3 -d...V/-(3yy <br /> PROPERTY OWNER INFORMATION: <br /> Name: Ink fr.?. Fr C/`°1 <br /> Phone(day): <br /> Address: ;,2,�,G.$ I�'e'i)- ere. � K RA_ City:O,rorl ZIP: 53 I <br /> cfir' <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): City: ZIP: <br /> Address: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: osal& <br /> e aDisp <br /> SewgDisp <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4. Wg S <br /> ❑New Construction tkingle Family with <br /> ktesidence <br /> ❑Addition attached garage arage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> III Relocation (�^�� detached garage 0 Office/Commercial 0 Private Sewer <br /> 1'4 Other:(specify) Pt,- 120CJ J 0 Multiple Family/Condo ❑Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> *"Any earth movement may also require ❑Commercial 0 Other(specify) <br /> M 0 Private Well <br /> CWD review&permits. 0 Industrial <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Estimated Construction Valuation(excluding land) $ Mt 000 <br />