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1 r <br /> � • <br /> • <br /> CITY OF ORONO � rj' S,3, 5� <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O MailingAddress: Permitnumber: ����'���' y <br /> PO Box 66 <br /> � � �/ Date received: �-�s -�� <br /> Crystal Bay, MN 55323-0066 ` � <br /> Street Address:' r ���� Received by: <br /> yF G� 2750 Kelley Parkway v � Plan review fee: � /lo�r �9 <br /> �yKFSH��`� Orono, MN 55356 p�0l�-Od0lo � <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 full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: t <br /> Job Site Address: �.?�j0 LAS(.r� ?ou�(' 'g-o�� (-p�,W t�►r,1G�N'('S Ot?-o►�o , P'�µ <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 approva160 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 /> ao-� � �- �3- a�- �'� <br /> CONTRACTOR/APP�CANT INFORMATION: O6Z� <br /> Name: L D��.� C-t�i�D Lo. �-�-C� <br /> State License# �(�(y3�jZ � Expiration Date: v3 31 20!'� <br /> Phone: cell V�Z.• 333 • O j�0 office (y t2.� ' ?j - � <br /> MailingAddress: �S05a 23� p.�� City: t��— t'loJTl� ZIP: SG�4�� <br /> Contact Person: �j�-Jt�FL SETI���R.. Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: 1� c•�o.�,[.�Dt�, C.orl � <br /> PROPERTY OWNER INFORMATION: `�� ���J�� LL� <br /> Name: .J�FF t��A �7l�t�J �v�JA�t` Qvu�f�, 1' <br /> Phone (day): q�Z - a?� -SoL?� " "" � <br /> Address: 40 Tl�tes [�IAY� I�A►�� City:l.F�D�lSNA7yGrs ZIP: ��j317 <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN �E,R INFORMATION: <br /> Name: L�;�p•?r1��L-S l.�'D� (.0. �-w <br /> Phone (day): �Z � - • t <br /> Address: I�iOSo Z3 4JF . City:��r'�"�1� ZIP:y�j��k7 <br /> Email and/or Fax: R,L,�'�IdtC r'�..p� l�p��-,uiC�. C,oe� <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage �Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) �/ <br /> ❑ Public 4-feet or greater UV Public Water <br /> "'Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � `T������ RECEIVED <br /> JAN � 9 2016 <br /> Last Updated: January 2016 <br /> CITY OF ORONO <br />