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L� ��� <br /> , a, ��- l� <br /> CITY OF ORONO , � <br /> BUILDING PERMIT APPLICATION � � •� <br /> � 7 � ..__ � =- <br /> FOR NEW STRUCTURES OR ADDITIONS - <br /> Q Mailing Address: Permit number: /S� - ��O 7 <br /> '� �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �`0�3-�� <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: ��.5�7 � - <br /> `�t,� � � Orono, MN 55356 o?p/cf_ppC� 7? <br /> kFSHO � `� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �sC�p� ap/c,�fjDO 7,s <br /> This application form must be completed in full and all required information must be submitted.,]l„ZspO. �- .�f2�_ <br /> Incomplete applications will be returned. (Please print) (� <br /> GENERAL INFORMATION: <br /> Job Site Address: �OS GRE�K 1�.�DC�� PA�SS <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 /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: GMARt� CvD o ��WOUa <br /> State License# p,,G63�245 Expiration Date: 3/ o� <br /> Phone: cell /z. /O.l / office �12, 33 .gQZ�U <br /> l�lailing Address: / OSa �. ,4,� /l,! City:'PL�NtCwtH ZIP: 5�yy7 <br /> Contact Person: _ ���+h,,c�un�ek Applicant is: �o� / Homeowner (Circle One) <br /> Email and/or Fax: �"��N��@ CH�S c�oi�•��''1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: JoH� � GN�Y �6iN <br /> Phone (day): 6/Z - �3C) -2 3o Z <br /> Address: 5°�Z�j �iEI.,�TO�UTG }�L,,A,�� City: �ND'E�.�JJ�E ZIP: S-�j 35`� <br /> Email and/or Fax '� Ro3��u7@,cx�c.x,� enr►� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Cf�AQ.�S Gup� D� �l/ov� <br /> Phone (day): 6/2 ,3�3. `$oZa (TiM McN�e[. <br /> Address: I;Or�-p Z'S�p ��� ti1 City: R-�D�'CN ZIP: �'�j�f`f7 <br /> Email and/or Fax. `T,H 1`�� CHt+.u.l�S C-��D•Ga/� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> �[Vew Construction �Single Family with �Residence <br /> '�]Addition attached garage Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ 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 movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ �� 2�C�' �'�-X� -d o <br />