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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> "O`Y Mailing Address: <br /> PO Box 66 Permit number: DG g '' �� <br /> Crystal Bay, MN 55323-0066 Date received: c73- ,2)6 4 S <br /> Received by: <br /> Street Address:' <br /> y <br /> 2750 Kelley Parkway Plan review fee: <br /> ,tilt:'''<lkEst-101-4" Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: 0. 5' , e0 <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> • <br /> This application form must be completed in full and all required information must be submitte4 yl <br /> Incomplete applications will be returned. ase print) <br /> GENERAL INFORMATION: 0 <br /> Job Site Address: co 7 by fYIA4,‘, r/ f-(G. d/i drawer <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ii 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. Shuttle bus servic- will.e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMA N: <br /> Name: L i3 C 3 -1 51'{t-e CP l C/t'-- <br /> State License# Ac 57 o 3%, ' Expiration Date: W'VLc r Za/ <br /> Phone: cell ..1.. i II 6 lir office <br /> Mailing Address: $ 0 • I PFJ I Cit :. re.: ZIP: 3S". <br /> Contact Person: o .A.,,_ Applicant is: o tr.ctor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION ^ <br /> Name: .-_-.-0 •7 ,' ()-- <br /> Phone(day): S�,� g 9 ) 7-,0Y .�,/ <br /> Address: ( 1 L'� 54- "-' - City: D %�'fi <br /> -5-6 \"- ZIP: S /2 //A(o <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: /(7/4 <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> N. Water Supply <br /> ❑ New Construction )Single Family with 111 Accessory Bldg./Garage <br /> /Addition attached garage 111Deck Public Sewer <br /> ❑Accessory Building (( ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation I ;),9 �p,,,b,,,,,;,r detached garage ''Residence ❑ Private Sewer <br /> ❑Other: (specify) 1.1tam //�� �❑�l, Multiple Family/Condo [' Retaining Wall(s) <br /> J r rt\ GxfxwLJ Public 4-feet or greater 0 Public Water <br /> **Any earth movement may o require 111Commercial ❑ Storage <br /> MCWD review&permits. 60-4-...i. ❑ Industrial ❑Warehouse iOZ.erivate Well <br /> Minnehaha Creek Watershed Di rict(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 v u <br /> Estimated Construction Valuation (excluding land) $ 1-000 <br /> Last Updated: January 2016 <br />