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� <br /> �j� <br /> CITY OF ORONO � " <br /> , /� �� <br /> BUILDING PERMIT APPLICATION `"Crl I �� <br /> ) <br /> FOR NEW STRUCTURES OR ADDITI NS _ <br /> /�O� Mailing Address: Permit nu . �7 I�� � C: C�� <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �-� � � � (S <br /> 'i� Received by. �� � �'1 � � � <br /> � a ,, Street Address:' .._-..�..__ -_--– _...._._—___ ----- �1� <br /> ` \�F G� 2750 Kelley Parkw •7� � �_G�'�� Plan review fee: � . � � <br /> \ESH�R�c, Orono, MN 55356 G <br /> Main: 952-249-4600 Total Fee: � <br /> Fax: 952-249-4616 wv✓„v.ci.orono.mn.us � � ��_3 �, � <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: ��Z S ��-��t—����.Q, , �,,c,�-��, ` �•J�v� S S 3`I \ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot Display Home? ❑ Yes [ No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> If- w� I� r�av� � �31�► rc��� } <br /> CONTRACTOR/APPLICANT INFORMATION: I' � � � � <br /> Name: �u,�.c S c1�as'S��r��-�n�. . �'� A� �ro�nr�� �z X�.�('�b�S <br /> State License # L."'J l S 3 U^1 Expiration Date: 3 3� � Z al�6 <br /> Phone: �ell) �a�2.-'1 S� ��-l.�{ O Z (office) <br /> Mailing Address: � �.�T � 2 to Cit : �Mo�p1,c�q�r. ZIP: S S 3 S <br /> Contact Person: �. p �- c.r Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: c, w • ' ` <br /> PROPERTY OWNER 1INFORMATION: <br /> Name: C Y���S�-c,�.• c' � . �cr�-y <br /> Phone (day): (_ �L _-t'3 5 - 3� to'Z- <br /> Address: ��.-L S- �'�-w�,G-y ��?�.r..� City: ��y�y.�., ZIP: �5�`� 1 <br /> Email and/or Fax c e �-- b rc C . �c,.,..�. <br /> ARCHITECT/ ENG_IN�ER INFORMATION: <br /> Name: 1 v..rY.��. �,4.c..F �c.S� �^ �o . <br /> Phone (day): (7 63 `-1 �E-- Oq°t "� <br /> Address: _ �-Z��,�.9Le.J c�,,--� �o� '�-, City: "� \�v�n ok� ZIP: S S�}�{ �} <br /> Email and/or Fax: , <br /> PROJECT INFORMATION: Description of pro�ect: I J�(C� ��,��1�� � �� iz 4�� � � '� <br /> J <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with [�Accessory Bldg./Garage <br /> ❑9ddition attached garage ❑ Deck ❑ Public Sewer <br /> [�Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence rivate 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. ❑ In�ustrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �'�ther: (,�pec(fy) � ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd '��.�r, `�S1n�4 <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n neha hacreek.or <br /> Estimated Construction Valuation (excluding land) $ �,pc�� c�a v <br /> Last Updated: January 2015 <br />