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<br /> ' CITY OF ORONO
<br /> BUILDING PERMIT APPLICATION
<br /> FOR NEW STRUCTURES OR ADDITIONS
<br /> ��� Mailing Address: Permit number: 17' (i�
<br /> PO Box 66
<br /> ...,._..
<br /> Crystal Bay,MN 55323-0066 Dafe received:' � � ""��a
<br /> � Street Address:' �7
<br /> Received by:
<br /> y� ��'� 2750 Kelley Parkway Rlan review fee; / �]��. (p !
<br /> ��'��'sxoR�' Orono,MN 55356 a,G� /(p ._ �D 3'
<br /> Main: 952-249-4600 Tc�tat Fee: � �
<br /> Fax: 952-249-4616 www.ci.orono.mn.us
<br /> �, .- �', ��$���.il��'�1� �78.
<br /> � ,, � � ` ��_
<br /> �. ,.,_. .�+�°;�Cp _,...... . �:�#�e_��ri�d»� (Please print)
<br /> �
<br /> GENERAL INFORMATIO�
<br /> Job Site Address: � r�; �r��r S{..,�,�,-} C f'`�+'-'�'j�� `-�-c� . S LS 4�,��,� +�-v�,
<br /> Will this be a Parade of Hoi!n , emodelers Showcase Home or other Display Home? Yes � Np
<br /> ff yes,a specia/event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttfe bus service will be I
<br /> required unless applicant demonstrat9s s�cient on-site parking is available. Non-permitted events will not be alfowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: Z�,i�,,,,.d�.x No,�-��s 'I r.cr '�
<br /> State License# Bc 5 4 z s S� Expiration Date: 3/3��i,o�4
<br /> Phone: (cell)�5�.�yo 3 � S�k� (office) �I
<br /> Mailing Address: k�� ,�ih ' rrarl S Cit : MuLoN.� ZIP: S�Fro
<br /> Contact Person: F,.:� Z�,.,d�,i Applicant is: tor / Homeowner (ClrcleOne�
<br /> Email and/or Fax: �r;Lz��.,�,;,�� zc�.d�f tiD,.,,,�s . �o,.,,�
<br /> PROPERTY OWNER INFORMATION:
<br /> Name:
<br /> Phone(day):
<br /> Address: City: ZIP: �
<br /> Email and/or Fax
<br /> ARCHITECT/ENGINEER INFORhIIATION:
<br /> Name: p F P Pk.-...,., s� ns.:; ►-. '
<br /> Phone(day): ��3� 7go - e4
<br /> Address City: ZIP:
<br /> Email and/or Fax: �
<br /> PROJECT INFORMATION: De cri tion of pro'ect: Res;d....,-.d,'o-1 Nca,,.� G�hs�Y.�;n�-,
<br /> 1.Type of Project 2. Proposed tJse �3.Str�rture Type 4.Sewage Disposal 8�
<br /> � Water Supply
<br /> [� New Construction �SingEe Family wiEh [�Accessory Bldg./Garage
<br /> ❑Addition att;eched garage ❑ Deck �j Public Sewer
<br /> ❑Accessory Building ❑ S;�gle 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 requir� ❑Commercial ❑Storage ,�,s
<br /> MCWD review 8�permits. ❑Industrial ❑Warehouse �ry Private Well
<br /> Minnehaha Creek Watershed District(MCWD) I ❑Other:(speClfy) ❑Other(speClfy)
<br /> 15320 Minnetonka Blvd
<br /> h4innetonka,MN 55345
<br /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.or �
<br /> .. i
<br /> Estimated Construction Valuation (excluding land) $ 3 5 5, �o a R�C�IVED
<br /> �� JUN 0 6 2016 ', �
<br /> Last Updated: January 2016 i
<br /> � CI'fiY OF ORONO I
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