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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> OA, Mailing Address: Permit number: 2o14- <br /> / •V� <br /> Crystal Bay,MN 55323-0066 Date received: It'Ap <br /> Received b BG S <br /> Street 50 Kelley y' 20t4 �cir <br /> �. � � 2750 Kelley Parkway Plan review fee: '•^+�.7 <br /> ei / Orono,MN 55356� 3 7 <br /> TotaJ,Fee: *a�.7 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 05317 U�_V'> ►3c Aco 11-orw VWf7/kJAi Mrd 1563C11 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes NNo <br /> N 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: '_�:>A 1A",It (N L <br /> State License# 6 L tx%6`38 2 Epirabon Date: <br /> Phone: cell office "16 3 -3-G"3'D7- <br /> Mailing Address: Z W•96. Ci i t4w/ t ZIP: i554-2-Z, <br /> Contact Person: 1 Cy- (L; Ley Applicant is: Contractor / Homeowner (circle one) <br /> Email and/or Fax: "-11V1 r'ifo.3 Z"o <br /> PROPERTY OWNER INFORMATION: <br /> Name: -R)M * ALi Ilk 64'0,11e <br /> Phone (day): <br /> Address: :0537 DlD ('fit/A AO City: YT-A ZIP: eX53 1 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> 'Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ElNew Construction ❑ Single Family with ElResidence <br /> ❑Addition attached garage 19 Garage/Accessory Bldg. ❑ Public Sewer <br /> EfAccessory Building-V2t TA-4r-tT GNW+t ❑ Single Family with ❑Deck <br /> Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacr ek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> I$ <br /> �-�C J oc <br />