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CITY OF ORONO <br /> BUILDING PERMIT APPLICATIdN �� <br /> FOR NEW STRUCTURES OR ADDITiONS ,�,�� <br /> Mailin Address: O �"� L <br /> �.�.� PO Box 66 Permit number: ���J"�� ��5O � �� �,y���� <br /> � Crystal Bay,MN 55323-0066 Date received: � � � � (� r' ,���., 1` <br /> y; ! '� �� <br /> Streef Address:' -Y• ,/�— <br /> �" 2750 Kelie Parkwa ��.` � ��l 'D� � <br /> y�, G,� Y Y � Plan reviaw fee: 7 <br /> lq �ti Orono,MN 55356 " ,� ��j � <br /> kE�sHo � - --- _ _ <br /> 'Total Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ekj }- <br /> This application form must be compieted in full and all required information mus e submitted. <br /> Incomplete applications wlll be returned. (Please prinf) i_ �..� ,c; � (' , ���'�l, , �� <br /> GENERAL INFORMATION: �-wt <br /> Job Site Address: �C� �T�e �cc� � /a-S <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? es No <br /> If yes,a spectal event permit Is requlrad wilh Police Department and C(fy Council approve160 days prior to the event. Shutt/e us senrlce wil!be <br /> requlred unless appilcant demonstrates su�ctent on-sl[e parking Is avalla6le. Non-permrtted events wlll not be a►lowed. <br /> CONTRACTOR/APPLICANT INFO MATION: n <br /> Name: y�Qf���� '�[k c��e s �aV�Crt'd�c.�c.�� ��'+C.- <br /> State License# (�,� ��,( q G, 1 Expiration Date; 'Z,-�r - 2v 17 <br /> Phane: cell f� �,s�c offlce (o �( 1 ' <br /> Mailing Address: �, Ci : �v� ZIP: S S y <br /> Contact Person: . 1 �e c,� ` ,�Appiicant is: on ra / Homeowner �ci«ie one� <br /> Email and/or Fax: � e C�� <br /> PROPERTY OWNER INFORMATION:t� �1 <br /> Name: 4(�f�`-� � K--f►S 1'�e."�'Gf 5 <br /> Phone(day): (91 - b - I 3 q /�� <br /> Address: c, ✓�c Cit :(.�J�C�/�G I� ZIP: S3�U <br /> Emaii andlor Fax b d • � . � - <br /> ARCHITECT/ENGINEER fNFORMATION: <br /> Name: �J'c(� 11'ec,}�nrct( DJ�('-�-�c� �r'a� �.-vc.�L�,c�c�c��� <br /> Phone(day): `�� - Z!3 � 6�'�r'� <br /> Address: i CiC�� W �.t�acl�cx'�' ��ve� S«�'��. 1�70 City:�,,,�,��� � ZIP_�S'35� <br /> Emaii and/or Fax: „�„,�q..�-(. �w�,.,�%1�r- N�T <br /> PROJECT INFORMATION: Description of ro ec#: <br /> 9.Type of Project 2.Prvposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> [�New Construction �Single Family with �Residence <br /> ❑Additfon attached garage ❑Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Buifding ❑ Single Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage `�Public Water <br /> **Any earth mvvement may also require ❑Commercial ❑Other(specify) <br /> MCWD review 8�permfts. ❑Industrial ❑Private Weil <br /> M(nnehaha Cresk Watershed Dislrict(MCWD) ❑pthe�:(spe�ify) <br /> 18202 Minnetonka Bivd <br /> Deephaven,MN 55391 - <br /> Phone; 952-471-0590 <br /> Fax: 952-471-0682 <br /> www,mfnnehahacreek.or <br /> Estimated Construction Valuation(excluding land) � � , �� 1��� <br />