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I y <br /> City of Orono 5J / <br /> Building Permit Application <br /> for New Structures or Additions ) /� /7 <br /> Mailing Address: Permit number: �, / 7-li/ J' <br /> 8:\j/4\ <br /> PO Box 66 _ yCrystal bay,MN 55323-0066 ` 4) Date received: - /�/q 7 -1 1 6 P' /� Received by: / / LStreet Address: �Jw \� (r))2750 Kelley Parkway C�}. \ Plan review fee: r3 /O Orono,MN 55356 <br /> ktsHos:t• Main: 952-249-4600 Total Fee: C7\0/7- <br /> Fax: <br /> 7\0/7.Fax: 952-249-4616 www.ci.orono.mn.us • mtJ , !) _Lik rl Alice <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: i 5a5 I GNC-) L-Ak-€ r (._\/ b <br /> Wiii this be a Parade of Homes, Remodelers Showcase Home or other Display Home? El Yes tA 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: r.`( ,gu . cam <br /> State License# 4,L-00 t3a.-1Expiration Date: v 3I2..0 iv, <br /> Phone: (cell) -j(03,. 9.4-1 6)OO 1 _.. _ (office) <br /> Mailing Address: j,4 1. taS <br /> city: ZIP: 5153 <br /> Contact Person: G_A - t .2 A___ Applicant is: ntract r / Homeowner (arae one) <br /> Email and/or Fax: _ <br /> PROPERTY OWNER INFORMATION: <br /> Name: �rarre_lI4. "w nr dj.-TR. Dz.-. ..s.t)ns.. <br /> Phone(day): (Q t,'2- ctO$,- ;3 a <br /> Address: ti 30 1�hE ASA*) r.6C ft- City:\ALN\"za 1F ZIP: S539( <br /> Email and/or Fax A b3-1 414z . G..0 L - coA,-- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: R_ 1 1 gN/CL.2 <br /> Phone(day): Rol__sa, - ,a-1yL ZIP: <br /> Address: 90 (1�oty <br /> i Cil,-A`c' <br /> Email and/or Fax: ?i(i l.. Q ( Ai c.. (aM — <br /> PROJECT INFORMATION: Descri.tion of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ,New Construction A Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck c:4 Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0 Office/Commercial <br /> E Relocation detached garage Residence 0 Private Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo 0 Retaining Wall(s) <br /> 0 Public 4-feet or greater ❑Public Water <br /> *'Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. El Industrial 0 Warehouse Private Weil <br /> Mlnnehaha Creek Watershed District(MCWD) El Other.(specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952471-0590 <br /> Fax: 952-471-0682 <br /> www.mi nehaha c•k.or. <br /> Estimated Construction Valuation(excluding land) $ <br /> PIEC 1VED <br /> Packet Last Updated: August 2075 <br /> ge 21 DEC��� O 7 2 q0 7 <br /> CITY OF ORONO <br />