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�� � � <br /> �05�� <br /> CITY OF ORON4 � <br /> BUILDING PERMIT APPLICATlON <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O,� TO Mailrng Address: Permit number: 7� � <br /> 1�� PO Box 66 <br /> Crystal Bay,MN 55323-0066 Bate received: �� �� <br /> StreefAddress:' Received by: <br /> y�, G� 2750 Kelley Parkway P]an review fee: D/'—OC� a1 D <br /> �qk�s�o�ti Orono, MN 55356 � � �30,�� <br /> Main: 952-249-46Q0 Total Fee: <br /> Fax: 952-249-4616 www,ci.orono.mn.us <br /> This application form musf be completed in fuil and all required information must be submitted; �� `,�/ <br /> lncomplete applications will be returned: (Please print) Gcr rr�,►I ��{- ���(�,�,y��' K�.t�W <br /> GENERAL fNFORMATION: ������� <br /> Job Site Address: 2`�(q�' tvocz-(►k �btv� pR . rr�ars M�.t S5 3� r <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes,a special event permit rs required with Police Department and City Councr!appraval&Q days prior to fhe event. Shuftle bus se�vice II e <br /> required unless applicant demonstrates suffrcient on-srte parking is available. Non-permitted events wilf not be allowed. <br /> CONTRACTOR!APPLICANT IIVFORMATION: <br /> Name: �J n.1 �1 1J Ga. /�.l L <br /> State License# '�G. 6 �1j Expiration Date: 3 I (g <br /> Phone: cell 1 office <br /> Mailing Address: 2 � Cit : t, AIZ.�': y2'Z <br /> Contact Person: W��.t,t Applicant is: C rac / Homeowner (CircfeOne) <br /> Email and/or Fax: _ i CROw�M� . GON� <br /> PROPERTY OWtVER INFORMATION: <br /> Name: P�. e �1 L►►',��- <br /> Phone (daY): �'�t2. 8yS-: �� � 1-1���. "Ca: l-�• fo GR L $y°�y 2'3 <br /> Address: 2�$S" No�l� S{�F-E nR. City: QR.p�sO ZIP: 5539�, <br /> Email and/or Fax _ -���L�C�M�x p� ,V S _—____--— , <br /> ARCHITECT/ ENGINEER INFORMATION: ' <br /> Name: ��-��G���1 ��ar�al.���pr <br /> Phone (day): {„11.c�Z,q Z�c90 <br /> Address: �12y i,a�-t- ���*-h r,�f` City:},,,�a►v����t� ZIP: ���f/0 <br /> Email and/or Fax: � r���or�1�P-h2a.2 w,rchi�-er�4-� ,�o� <br /> PROJECT INF�RMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4,Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construcfion �Sinc�fe Family with ❑Accessory Bldg./Garage <br /> ��.,^f,ddition attached garage ❑ Deck �Public Sewer <br /> LJ�Accessory Building ❑ Single Family with ❑Office/Commerciaf <br /> ❑Relocation detached garage �Residence ❑ Private Sewer <br /> ❑Other:(specify) ❑ MuEtiple Family/Condo Retaining Wall(s) <br /> ❑ Pubfic 4-feet or greater ❑ Public Water <br /> *"Any earth movement may also require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ Indusfrial ❑Warehouse ��rivate Well <br /> Minnehaha Creek Wetershed Disfrict(MCWD) �Other:(specify} ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 "- ------- — <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) � �°q�d ��� pG�►�,�U�D - <br /> MAR 2 3 2017 <br /> Last Updated: January 2o16 <br /> qTY OF OR4N4 <br />