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q <br /> • <br /> CITY OF ORONO4? \ <br /> D\ <br /> BUILDING PERMIT APPLICATION \ <br /> FOR NEW STRUCTURES OR ADDITIONS d��ri <br /> �0 VO Mailing Address: Permit number: 0't /7- L` <br /> Ad <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /1-I 5-17 <br /> Received by: ,ytn` <br /> A , <br /> Street 2750 Kelley <br /> o� <br /> ti� �� Kelley Parkway Plan review fee: 0 <br /> � 4-Es Orono, MN 55356 a0/7 - �/J�oZ/ <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us ,(X( <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: 1,307 Ct 71 �- ?cR,, (2--i, <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: Cit t--- `jt -G�j . c.sc- <br /> State License# ( '�jCT v Expiration Date: !'i:4 ZbC 6 <br /> Phone: (cell) 2 -2- -c 342— (office) t_02-7-4---14-1`sS <br /> Mailing Address: (;,vZb-, 4:7I ya.,..3.(-4-bLG S:� City: i ( ZIP: )L1&j 55M.9 <br /> Contact Person: :1: t'� T___S-64,4AN--.) Applicant is: on rac / Homeowner (Circle One) <br /> Email and/or Fax: f,,; �tNE7_Ci1 .�..,.►ck). c�4 <br /> PROPERTY OWNER INFORMATION: <br /> Name: e 4t L(r/z.5.OLSc) <br /> Phone(day): ,,.5./-4 44-'z_- G S (°-1 <br /> Address: Q F zg-c--lr5 tur City: c)\,jv ZIP:5j 1 <br /> Email and/or Fax Gilac.c_ µ,op-L)Q4_)� c) cin t,1-4_.«;,ti <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: F ' RSs:c Li-T&5 <br /> Phone (day): 6261 -3 4,4,---2-6e/5- <br /> Address: <br /> --Z 5Address: City: ZIP: <br /> Email and/or Fax: CR-cc jQG (3c j, y.4-A.;, A-SSc-C-1.4,- . c0M <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 0 Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage 0 Deck 0 Public Sewer <br /> f21-Accessory Building Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage 0 Residence 0 Private Sewer <br /> ❑Other: (specify) 0 Multiple Family/Condo ❑ Retaining Wall(s) <br /> 0 Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse pr..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 /> Estimated Construction Valuation (excluding land) $ f' 1 - tZelt=EIVED <br /> NOV 1 5ZUii <br /> Last Updated: January 2016 <br /> CITY OF ORONO <br />