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. <br /> City of Orono 95). <br /> Building Permit Applicatio <br /> e‘ <br /> for New Structures or Additio <br /> Mailing Address: 2� 5_ i <br /> PO Box 66 Permit number: /8 <br /> +�lit-OA/0 Crystal Bay,MN 55323-0066 Date received: / / ` 3-I S <br /> / Street Address:' Received by:�_�_ - f1./�. <br /> -' 4i, <br /> 2750 Kelley Parkway c d�9� �, c,` Orono, MN 55356 4-2401 sC.) i, Plan review fee: 3`7 PvrsA , <br /> �'ktsHos' 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 INFORMATION: <br /> Job Site Address: 330 W:4�uNnoe< / ,c /Lt <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 1 APPLICANT INFORMATION: <br /> Name: K adv-nso,-, G,)-,z4(....,-kor\ Li`c. <br /> State License# Qc oag aag Expiration Date: 3/3I / ) 1 <br /> Phone: (cellW 2,) q i'-'q-32 0 (office) <br /> Mailing Address: 3-42,q D,,,por.4- Aut Se.--A, Cityi ;s- ZIP:-SS 4461 <br /> Contact Person: QyAN Ho(-kr\ Applicant is: ontract / Homeowner (Circle One) <br /> Email and/or Fax: iry.t.,,, Rle.,Jol..nson co r1S4ru :wl.LO"y, <br /> PROPERTY OWN R INFORMATION: <br /> Name: etre- 54re-s-ser <br /> Phone (day): ((o}?) 3o6- 405a, <br /> Address: 8.33' W;-,d3?4✓I4.ytei (,eti,e- City: Orono ZIP: SS 3,(1--( <br /> Email and/or Fax M cir(2 5--r-cs5er'®r4.ic .coAA <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Ks-\\-v-) Ate xc,•,etg r- <br /> Phone (day): (/c1'SZ) y-43-$-4-w-R- <br /> Address: L4o1 r.,,- [.,,L, SA City: U Jci Z -c,1-c, ZIP: S$3`t <br /> Email and/or Fax: Ke.,-0".-0". J ry n® Alp xcLA.lo K cte ,s,/ (...,--p.co/ <br /> PROJECT INFORMATION: Description of project: •P-CIL add t'f a S <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction .1 Single Family with 0 Accessory Bldg./Garage <br /> Addition attached garage ®Deck tij Public Sewer <br /> ❑Accessory Building 0 Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 0 Private Sewer <br /> ❑Other: (specify) 0 Multiple Family/Condo 0 Retaining Wall(s) <br /> 0 Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse X Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 64 6.33 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />