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CITY OF ORONO f4iggt6BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A, Mailing Address: Permit number: 13 <br /> ��W <br /> PO Box 66 Date received: <br /> Crystal Bay, MN 55323-0066 /! -' -/ <br /> n, \‘`/ Received b '. <br /> A , �J' \''° Street Address:' �( <br /> �\ 2750 Kelley Parkway ( 1,0i C�Plan review fee O(4 _ ,04. 02�Orono, MN 55356 `I� _ _ <br /> kES M0 Main: 952-249-4600 <br /> Total Fee-----------44(4-.,0 // <br /> Fax: 952-249-4616 www.ci.orono.mn.us . / ; • y <br /> This application form,must be completed in full and all requiredfi nform ation must be,submi / y,fma'-' <br /> Incomplete applications will be returned; (Please print) / <br /> GENERAL INFORMATION: <br /> Job Site Address: 500 O/! C Fy544j , ,,Ie'.- T <br /> Will this be a Parade of Homes, rcemoaeiers Showcase Home or other Display Home? ❑ Yeso <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: 1 v orforN {f"Ur»-2 S, L C c_ <br /> State License# BC (a 3S?-.--( Expiration Date: 3-,3/ -/ •) <br /> Phone: (cell) (p t )-- 3860-7 6,6,/ (office) 7&,3. .5:59-399/ <br /> Mailing Address: / fr)-15OA- Aye /V s. 0 City: �Yi7ya/ • SS •!� <br /> yc , <br /> Contact Person: ri - r 120... Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: G rise k or- nl' [1✓Y)t.S. CCn . <br /> PROPERTY OWNER INFORMATION: <br /> Name: CA(i S N dr---Dv` <br /> Phone (day): (o t'1- - 311,- 7 re L t <br /> Address: /F2-/s ''5 //ve A/ City:r/y y ,,r)-L. ZIP: c-Syy‘.; <br /> Email and/or Fax Cl rig,t )40r4oi--/-10>4.-<5 c , <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: £ P P la/ern I`1�tl s..0-G5 i,n <br /> Phone(day): 7te 3.1 FSO - ' t1 C f J <br /> Address: 9/0-0 8a-/tt%ncree Si. Air Sk /OCQ City: &fib r1.(_,, ZIP: .575-cY9 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type o Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ew Construction ❑Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage El Deck 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with El Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater • ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse El 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 /> L <br /> www.minnehahacreek.orq 7-` <br /> • <br /> Estimated Construction Valuation (excluding land) $ Y‘s— <br /> ,,,..ago OCT 2 0 21116 <br /> CITY OF ORONO <br /> Last Updated: January 2016 <br />