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� � i <br /> �,D <br /> CITY OF ORONO 7J �O` <br /> � � <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> /"��'� Marling Address: permit number. � �a �y�/ <br /> i� ���� PO Box 66 <br /> ,'� � Crystal Bay,MN 55323-0066 t Date received: � — -(� <br /> � ! Strest Add�ess:� � Received by: �� <br /> �,�y =� 2750 Keiley Parkway Plan review fee: <br /> �C�KfS110��`v/ Orotlo,MN 55356 2 D 'D � <br /> __._ � Total Fee: p�O I J� � <br /> Main: 952-249-4000 Fax: 952-249-4616 www.ci.orono.mn.us ' c� . p• <br /> This application form must be completed in fuii and all required information must be submitted. <br /> incomplete apptications wiil bs returned. (Please print) <br /> GENERAL INFORMATION: ,� <br /> Job Site Address: 7 �.a�'�=.i It..wt,'1�!l't1%. ��''�'?'t11��,1 .- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes ` No <br /> !f yes,a special evont permit is requl�ed with Police Ocpartment and City Councrl approval 60 days pria�01he evertL Shuflle bus service wdl be <br /> re�uired unless applican�demonstrates suHicient on-site parking!s avaifablo. Non-permiftod events wil!not be allowed. <br /> CONTRACTOR/APPLICANT I FORMATION: n <br /> Name: �..��—�V�ft,� ; ��.�.�kYl�'rS tl►'iC �a��� <br /> State License# _j3�UQ p �q U'} Expiration Date: �,���,11 �110 <br /> Phone: (cell) l?l1-'iY�a '3�11� ��ce �3_4�Z� - =f S�i�-f i,}-� �y� <br /> Mailing Address: ��r 3?y j'h,nn[-te�nlr�_�v_'G� _ Cit : F�•r�"'-_-ZIP: �j��'��j� __ <br /> Contact Person: ��;�,, Appiicant is: `yontrac�for�}/ Homeowner �c�.�ia o�.� <br /> Emaii andlor Fax: �n Q. Z���V�t_ un}_�G�.vth�r�.:_.� r-� _._ <br /> PROPERTY OWNER INFORMATION: <br /> Name: 7 ti'v vl��:Zi.r !�.-s'�;a r#�vte.�,`r'-, <br /> Phone(day): - ! � �- ' 7r� d 6�fSaa • <br /> Address: �-L`f��,`z -�-} CitY:��,C�I'r1•��: ZIP: '�=J��7,`:/0 <br /> Email and/or Fax <br /> �_(iv;�r!,,Gi h � lrA.V C LZ. .�i4 rl'7 . _-- --- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: `�r^�;�.,f f%1.��� �.if f,i�;r"1 +�.,-3Y�-r'��1 <br /> Phone(day): i:��... �+��� � 1 _�. <br /> Address: rrl� �,C!'�+�R `Y�,-tS�}'" ...��v tK �Ub -- City�.�.Y i=����.:�� ZIP: `�`� �_`�— <br /> Email and/or Fax: ;r`�-7 ����}-,�f4►S�a„-� . (;a�i--s <br /> :�� <br /> PROJECT INFORMATION: Qescriotion of project: <br /> 1.Type of Project 2.Proposed Usa 3.Structure Type � 4.Sewage Disposai 8 <br /> � Water Supply <br /> �New Construction (�Single Family with � [�Residence <br /> Addi6on attached garage ❑Garage/Accessory Bidg. � �Public Sewer <br /> ! ❑Accessory Buildirx� ❑ Single Family with ( ❑Deck <br /> I ❑Relocation detached garage ❑Office/Commerciai ❑Private Sewer <br /> ❑Other.{specify} ❑Multiple Famiiy/Condo ❑�Narehouse � <br /> ❑ Public ❑Storage i i j,Public Water <br /> "'Any earth movement may also require ❑Commercial ❑Other(specify) ' � <br /> MCWD review�permits. ❑Industrial � ❑Private Weif <br /> i tilinnehaha Creek Watershed District MCWD � ! <br /> ( ) ❑Other.(specify) <br /> i 18202 1�linnetonka Blvd <br /> ! Deephaven,MN 55391 '- - <br /> � Phone: 952-4I1-0590 <br /> i F2x: 952-471-0682 � <br /> i wwvr m;nneh2h�CrCek orq � � <br /> Estimated Construction Valuation(excluding land) � �-� �t ��� <br />