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� <br /> , � :, �:�,;,5 ��� RECEIVED <br /> � , - �� � CITY OF ORONO <br /> JUN 21 2016 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS ORONO <br /> OA, Mailing Address: � Permit number. Z U� �'' " UC' � � <br /> � `VO PO Box 66 � � <br /> I Crystal Bay, MN 55323-0066 � I� Date received: �r—Z I – Co <br /> Street Address:� �j' �'I Received by: _j�� <br /> y � 2750 Kelley Parkway�-� Plan review fe <br /> F <br /> (qkfSH���` Orono, MN 55356 ����� <br /> Main: 952-249-4600 Total Fee: , <br /> Fax: 952-249-4616 � 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: <br /> Job Site Address: 3375 CRYSTAL BAY ROAD, WAYZATA, MN 55331 <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 approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sulficient on-site parking is available. Non-permitted events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: VILLAMIL CONSTRUCTION C0. <br /> State License# BC 6 3 3 7,3 o Expiration Date: 0 3/31/2 O 1� <br /> Phone: (cefl) 612.221.7511 (office) <br /> Mailing Address: 5535 COUNTY ROAD 151 Clt : MINNETRISTA ZIP: 55364 <br /> Contact Person: zAN vzLL�rL Applicant is: ontracto / Homeowner �ci.�ieo�e� <br /> Email and/or Fax: IArrvIiLAMIL@�t�IL.coM <br /> PROPERTY OWNER INFORMATION: <br /> Name: JASHUA JABS & NICOLE JABS <br /> Phone(day): JOSHUA 352.564 .5215, NICOLE 352.500.2105 <br /> Address: 3375 CRYSTAL BAY ROAD Clty: WAYZATA ZIP: 55331 <br /> Email and/or Fax JOSHJABS @HOTMAIL.COM, NBARTZ@YAHOO.COM <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: F�ASLo vzLLAMZL <br /> Phone(day): 612.388.6622 <br /> Address: City: sAZNT F�AUL ZIP: <br /> Email and/or Fax: cRuzLo�zc@�r�zL.coM <br /> PROJECT INFORMATION: Description of project: __ <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal8� <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 ❑ 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 (�cck •.l �+�.����R� <br /> Fax: 952-471-0682 R E P�T R <br /> www minnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ �lo,00v.00 <br /> Last Updated: January 2016 <br />