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i <br /> City of Orono linsq /2s/,� <br /> Building Permit Application` 9 -7y , 61)— <br /> for New Structures or Additions._ <br /> Mailing Address: a'o/t'o_OD 7 5 <br /> Q PO Box 66 Permit number: <br /> W Crystal Bay, MN 55323-0066 Date received: 4 -4'7 lb <br /> Street Address:' Reccoi d by: "k//C <br /> y 2750 Kelley Parkway Plar r1 eview fee: b J 9`74'. 70 <br /> Orono, MN 55356 / - L�7 f <br /> 4E8H0v-' Main: 952-249-4600 Total Fe r <br /> Fax: 952-249-4616 www.ci.orono.mn.us ESU'OW <br /> This application form must be completed in full and all required information kust be submitted. ,,fJ <br /> Incomplete applications will be returned. (Please prin p3O/(o-�U7 6-9 -f ilL <br /> GENERAL INFORMATION: C%L 37( <br /> Job Site Address: ( ( i S Moo Niel( Lp4i >1-41.v <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes n No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shu tle 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: 4.14P47. .tS Cub O Co. I,,..L...C . Job 5"P te lZ- zgz.' % 7 3 Va'4'1 <br /> State License# Be- (035 Z -S Expiration Date: — Zol'? <br /> Phone: (cell) Col Z_ 00- 714-Z (office) (012- 351- /70 <br /> Mailing Address: 0 , 20 . VE- , , , Cit : roti ZIP: 5 <br /> Contact Person: Sjrtj L,cI- - '-' Applicant is: 4 on rac . / Homeowner (Circle One) <br /> Email and/or Fax: .5LiGk-T ! ci.4.dlz,Lgi-'S Cu0a coM. <br /> PROPERTY OWNER INFORMATION: <br /> Name: Ti M ADE-'t-,1.44 <br /> Phone (day): G51- 5`T Z-- 77!07 / <br /> Address: 5'545 'Teu <br /> ic- tv� .al' /Gol/rieritSS-3 ,: S7 <br /> 3 0 ZIP: <br /> Email MTADE- ANAI e AD 144 a re . Cor-( > <br /> ARCHITECT/ENGINEER INFORMATION: Q,bl'Q OU'O <br /> Name: 5142 ARct-4 i 'cr , <br /> Phone(day): -74,3- Sell- Gus- <br /> Address: <br /> o (ISAddress: 11 14-0 141( fivhY SS- City: 7i_VMmU7-t ZIP: 5544-I <br /> Email amdkio.F.€6*- f L><1 NE MPrN e- Sg (T-CC'S .Gol 1 <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> XNew Construction Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage Deck ❑ Public Sewer <br /> ❑Accessory Building I>f Single Family with ❑ Office/Commercial <br /> LI Relocation detached garageResidence X Private Sewer <br /> ElOther: (specify) CIMultiple Family/Condo Retaining Wall(s) <br /> ❑ Public 4-feet or greater LI Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse IX,Private Well <br /> Minnehaha Creek Watershed District(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.orq <br /> 00 RECEIVED <br /> $ <br /> Estimated Construction Valuation (excluding land) ( , 700/ Clt;jd <br /> JUN 2 9 2016 <br /> Packet Last Updated: August 2015 <br /> Page 21 CITY OF ORONO <br />