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t� � <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 <br />