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<br /> CITY OF ORONO
<br /> BUILDING PERMIT APPLtCAT10N
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> � A, Mailing Address: ���_ � �
<br /> `vQ PO Box 66 Permit number. �
<br /> Crystal Bay, MN 55323-0066 Date received: �. �7 �l lp
<br /> a ,. Street Address:' � ��----�_ �
<br /> �'�� G. 2750 Kelley Parkway ���p'a� �� Plan review fee: 5 r S
<br /> �k�'SHo�� Orono,MN 55356 �[_, �
<br /> Main: 952-249-4600 Total Fee:
<br /> Fax: 952-249-4616 www.ci.orono.mn.us
<br /> This application form must be completEd in fuil and ali r�quired infoRnation must be submitted.
<br /> fncomplete applications wilf be returned. (P/ease print)
<br /> GENERAL INFORMATION:
<br /> Job Site Address: �� �� � e �'
<br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Disptay Home? Yes o
<br /> If yes,a special event peimit is required w#h Police Department and City Councii approval 60 days prior to the eveni. Shuttle bus service wid be
<br /> required uMess applicant demonstrates sulficient on-site parking is available. Non-permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT IN`F,OR ATION:
<br /> Name: ��s s� _— N►OC��r� �sC�-��'^ A� �1/lr nvl�Sc�s•� i rC
<br /> State License# f�.��[g �a s� Expiration Date: ,��,��-
<br /> Phone: _(cell) 95�-�� 7- l F,�7 (o�ce) �6� -aoo�-6 3��
<br /> Mailing Address: \�1 ,.v�u,� � j.} ,v,,•� City: CII� R:v.�.� ZIP• �5 3�c�
<br /> Contact Person: y� � �-,.},,,.. Applicant is: C�p_rtTr'�cf��l Homeowner (Circle One)
<br /> Email and/or Fax: "e.1 �J yvt� Q,�r �„s.}�w,,.�.,�r �v,✓�. ��,,,�
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: �,�c � ��u,c.�tss
<br /> Phone(day): ��3 � aa9- 5 g�E
<br /> Address: ,��4s�( L�1� 51.,,,.,,.� i�,'� CitY' �nee �.- ZIP•
<br /> �'lu 55 3 5�
<br /> Email and/or Fax LoJ� y'7b C� 1���Ew,�.;( , � -�-
<br /> ARCHITECT 1 ENGIN�ER INFORMATION:
<br /> Name: 1 ,�,� +�1�,,,",.� �
<br /> Phone(day): '76 � 7 K 6 -d o �
<br /> Address: �d 3�9 Gw,,1.«.1 ��; Cit�,�.,�� Lk � k ZIP' S,�'�3 a
<br /> Email and/or Fax: _�/,z� T�
<br /> PROJECT INFORMATION: Descri tion of pro'ect: ���
<br /> 1.Type of Project 2.Proposed Use 3.Structur Type 4.Sewage Disposal8
<br /> Water Supply
<br /> ,�New Construction �ngle Family with ❑Accessory Bldg./Garage
<br /> ❑Addition attached garage ❑Deck
<br /> ❑Accessory Building ❑ Sin fe Famil with ❑Public Sewer
<br /> ❑Relocation 9 y ❑ �ce/Commercial
<br /> detached garage 0""Residence �Private Sewer
<br /> ❑Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wa11(s)
<br /> ❑ Public 4-feet or greater ❑Public Water
<br /> "*Any earth movement may also requlre ❑Commercial ❑ Storage
<br /> MCWD review&permlts. ❑tndustrial ❑Warehouse `�rivate Well
<br /> Minnehaha Creek Watershed District(MCWD) ❑Qiher:(SpeCify) ❑Other(specify) /
<br /> 15320 Minnetonka Blvd
<br /> Minnetonka,MN 55345
<br /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www,minnehahacreek.o
<br /> Estimated Construction Valuation(excluding tand) � ��, �y`�
<br /> Last Updated: January 20J6
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