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� <br /> City of Oron ���0 <br /> , ' Buildin Permit A lic�tion <br /> J pp ��5� �L� <br /> for New Structures or Additions <br /> Mailing Address: : - <br /> ��T PO Box 66 <br /> Permit number: �� �— (� <br /> � `w(� Crystal Bay,_MN 55323-0066 Date received: g '� -- ,- <br /> Sfreet Address:' ��—�., Received by: C� <br /> �,F ; 2750 Kelley Parkway � �/�f Plan review fee: ��> � C' , <br /> c, O r o n o, M N 5 5 3 5 6 �- <br /> j�kESHO�� Main: 952-249-4600 Total Fee� --------- --�-�- ���`I <br /> Fax: 952-249-4616 w,vw.ci.orono.mn.us ✓ <br /> This application form must be completed in full and all required information ust be siJbmitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � y� LEr�Y' S 1 <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 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 will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �-�SZ.�C.C-� K�--r-��r,�w�+� <br /> State License# Expiration Date: <br /> Phone: (cell) (ol Z - 2�t,�— ��OU (office) <br /> Mailing Address: _ F Cit : ��''���w �S 3 S(v <br /> Contact Person: �fL�� �<q-1z..yrr�,�llZ� Applicant is: Contractor / omeowner f (Circle One) <br /> Email and/or Fax: �K�����p�►L � ��,� , � csm <br /> �" <br /> PROPERTY OWNER INFORMATION• <br /> Name: (arec►�� Kc��cL�vnc�-✓1< <br /> Phone (day): (�2.2pS-�ga e:� <br /> Address f yp L�p,-p ST City: C5✓t{rc� ZIP: $�3'ZF <br /> Email and/or Fax q Kctk�,�-,c.✓i� (� ct wi�, � . Luw� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <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 ❑ Septic <br /> �Other: (specify) �� ���+�� ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd;Minnetonka, MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> ry <br /> Estimated Construction Valuation (excluding land) $ D <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />