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Oe- f.75ii <br /> , . <br /> � , <br /> 15 <br /> • , <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION t-� <br /> I <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> icLO!V Mailing Address: Permit number: dOi 4- o- <br /> 4.5.. <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: / —/3 —/ <br /> Street Address:' Received by: /Y�� <br /> A14 <br /> 2750 Kelley Parkway Plan review fee: "P07 73 4/ 39 <br /> t'tesHo�� <br /> Total Fee: 7`G Orono, MN 55356 de, / —6.--e-e,3 57 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ?axrcitiraid-- 1•L •14f. <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: 2360 WILLobAl tILL bRtyVORo1lo <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes E1,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/AP LICANT INFORMATION: <br /> Name: f�1•31bEt— Hogg LIZ <br /> State License# SC.-(Q230, Expiration Date: 3/ �jr <br /> Phone: (cell) 6(2-4o-f 13p (office) cig2-4o4- <br /> Mailing Address: 15250 (k)h -cq gyp, -(og Cit • ZIP: S3q[ <br /> _ <br /> Contact Person: F(G1{ PJ E(_ Applicant is: Contractor / Homeowner (circle one) <br /> Email and/or Fax: Rlc14-41HENpe-MAE-5.Cr <br /> PROPERTY OWNER INFORMATION: <br /> Name: Jt r 1 rAthA tyro. <br /> Phone(day): <br /> Address: (61000 3ts' pt- p, City: D( ZIP: 5s 7 <br /> Email and/or Fax JfAvr.gmAtg bELUI.E.cPIA <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: a-Italia i Ae'cIbIJ <br /> Phone (day): a78 - $094 <br /> Address: gypd - t City: tiAAJF ZIP: f;64-9 <br /> Email and/or Fax: 763-7e0-80/(-) <br /> PROJECT INFORMATION: Description of project: _ <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> 5 New Construction Single Family with (g[Residence <br /> Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial 0 Private Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial (Private 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 /> Estimated Construction Valuation (excluding land) $ 6, C7 ICOO. 00 <br />