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City of OronQ <br /> . . . � , � � � l <br /> , Buifdinc� Perm�� �1p�s�Lcation �i�� <br /> � for �lev� S�r�c�t�res or �4dditio�s <br /> Mailing Address: <br /> � �Q PO Box 66 Permit number: O`7� � � <br /> Q Crystal Bay, MN 55323-00 � Date received: b/ / <br /> Street Address:� (�� Received by: <br /> � ,� 2750 Kelley Parkway �� � <br /> y�' L� Orono, MN 55356 � Plan review fee: g!� <br /> t�KESH04�' Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 ti�,�an��.ci.orono.mn.u� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applicatlons will be returned. (Please print) <br /> GENERAL IIVFORMATION: <br /> Job Site Address: v )��l� `��,��, ��o,�� M�l ��3� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non permitfed events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �����Pl� � �J�•.---�� <br /> State License # �Y-7'��S Expiration Date: �-I/��� <br /> Phone: (cell) C6 t z) xo(-�Zct 3 (office) �6 iz.) �� —6 zq3 <br /> Mailing Address: � �ci,-,�,�mK �o�.,.r- Cit : G�4s�� ZIP: S53 � Sr <br /> Contact Person: �f����-�,p�� ��,,,�� Applicant is: n ractor Homeowner (Circle One) <br /> Email and/or Fax: �,,�w k�fcs-l-�,a.-+�i�o�-.-tc4,-f hc-f <br /> PROPERTY OWNER INFORMATION: <br /> Name: . �,� �w�,��-F- <br /> Phone(day): �i Z Z�a-7.��� <br /> Address: y�'l� �(� ,,.� '�r=�vL, Cit :��o..o ZIP: ,j 36 <br /> Email and/or Fax r1o�,NG,r�� �,.,���� �m,_..., <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: Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro'ect: ^ ��� /2c�,cfc � <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> ❑ New Construction Water Supply <br /> ❑Single Family with ❑ Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> 9 y ❑ 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 8 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.m innehahacreek_oro <br /> Estimated Construction Valuation (excluding land) $ �� � ppCj �� <br /> Padcet Last Updated: January 2016 � <br /> Pa.qe 21 <br />