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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: 00:7:0 JO b <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 \A Date received: 7� <br /> StreetAddress:' 'y� Received by: <br /> 2750 Kelley Parkway 40Plan review fee: ill L41 .70 <br /> t9'rES H ov-� Orono,MN 55356 A0/7_ego As <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <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: 25— C Lo c:52\,/ Joo-)4 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes gNo <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: -I . “— }} m <br /> State License# b G 112-30 i Expiration Date: <br /> Phone: (cell) 6012, - 13c. r&2(4,4 (office) 952,. L)&j —nog <br /> Mailing Address: / Z 5 ' WA-12.A:TA (3L,LD_ City: W, 7.ATA ZIP: 56391 <br /> Contact Person: C _ _ Applicant is: -on rac o / Homeowner (circi.ons) <br /> Email and/or Fax: •--t-p,c)Stirs 407 e Npc�1-\c t S, c.•c M <br /> PROPERTY OWNER INFORMATION: <br /> Name: t-t AND ClbR1s-TirJ 'IAVA�- <br /> Phone (day): <br /> Address: ky•?o q ) ST. p),sc..F' IJo. City: rVIApig 6Rocc ZIP: 553)1 <br /> Email and/or Fax C-i(1/,L.- 6"114 'MSnt,cdM <br /> ARCHITECT/ ENGINEER INnFFORMATION: <br /> Name: Cl 0S jay l-r�c.Ts <br /> Phone(day): Lb)2 - <br /> Address: 4.. )tog Sv t-r 36- City: Nzu, ZIP: 5-54/ <br /> Email and/or Fax: - 9.1 I �m) GO/i4C.A)S--r, <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> [$flew Construction Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation detached garage cad Residence 6Private Sewer <br /> ❑Other:(specify) 0 Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑Public 4-feet or greater 0 Public Water <br /> **Any earth movement may also require 0 Commercial ❑ Storage <br /> MCWD review&permits. 0 Industrial ❑Warehouse (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.m i n ne ha hacreek.o rq <br /> Estimated Construction Valuation(excluding land) i 2 �U fir' RECEIVED <br /> AUG 2 81011 <br /> Last Updated: January 2016 <br /> CITY OF ORONO <br />