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CITY OF ORONO <br /> il ,,, ...„0 <br /> BUILDING PERMIT APPLICATION J gD�,7501/4-/ <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OfvMailing Address: Permit number: a0 J 3— o0�07 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 5-24.---/3 <br /> StreetAddress:' Received by: BqJ <br /> a ,�os,� <br /> -k 2750 Kelley Parkway Plan review fee: > I[[- 35v.&.8 <br /> G�•� <br /> lykfSti&- L Orono, MN 55356 ao/3—DQ Ye* <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us a5CXow (012;13 <br /> This application form must be completed in full and all required information must be 4ubmitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: a3ar- <br /> Job Site Address: 10k- I $lec 1i �i llou i-kIA <br /> Will this be a Parade of Homes, Ftemodelers 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: 144-V\ o►rvruZ- <br /> State License# re C., 112-308 Expiration Date: slit lS <br /> Phone: (cell) WI -to Ii _ -.c (office 912 -461,-71-04 <br /> Mailing Address: 152-50 t vd 5u:k4z._ t LA Cit : ZIP: 5 5 Sct <br /> Contact Person: Nca-e- ..1�V vvv-k- Applicant is: "bntractor / Homeowner (Circle One) <br /> Email and/or Fax: Yl&+e, aD k v Lj 1,-‘owAtL S. co <br /> Fp,tkp( CacriKr%2AIv To t.6uo elan @.hcRcQeih.mts.c-In 612- 1f g- 216'1 CiGsiL) <br /> PROPERTY OWNER INFORMATION: <br /> Name: '- i t& 4 AiN,w-Q. 6vu.&v.-1k_ <br /> Phone(day): 95a--1/11 - VI('?- <br /> Address: ID 85" Wif o VRQ& DIrcvt- City: nY o\A.° ZIP: <br /> Email and/or Fax bilkyi& .a V--w j. cokn,\. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: W iymivuwA' ' ex -,1,. S.1v.a-`c. <br /> Phone (day): q 5.1 _ 2S'o—IgNI <br /> Address: aq5 yz..,;,tlitvie.k.oi,r,'\r , City: 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 /> ew Construction ,�,� Water Supply <br /> Single Family with rcesidence <br /> ❑Addition attached garage El Garage/Accessory Bldg. [' Public Sewer <br /> ❑Accessory Building El Single Family with [' Deck <br /> ❑ Relocation detached garage El Office/Commercial Q Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo El Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. El Industrial ['rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> 00 <br /> Estimated Construction Valuation (excluding land) $ C/ -i 0CDO <br />