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f _ . <br /> City of Orono /pro. 33 <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Peri 20 (4j-(�0 IO D g <br /> SONO <br /> Crystal Bay,MN 55323-0066 kv PO Box 66 <br /> /``�[....t; D�te? i tc • ._,(0.,_.-4. --7,--- <br /> 1 p -N, Street Address.•• Receivedke89 EDI <br /> o J' *� <br /> 2750 Kelley Pa y P c'L 3q321, Iio- a4LL 3s �` ----__________TD.... <br /> Orono MN 55356 2.0 5 er f iwle • ^ Liz.•IcESHoy:" Main: 952-249-4600 -C-> Arp tyy -ft, Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.tis . <br /> This application form must be completed in full and aft required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 1t2jD 01•D LRy . R-C 1? SCor4-J O NMD J s5341 <br /> Will this be a Parade of Homes, Remodelers Showcase Hbme or other Display Hbme? dYes NI No <br /> If yes,a special event permit is required with Police Department and City Council approval 80 days prior to the event. Shuttle bus service writ be <br /> required unless applicant demonstrates sufficient on-site perking is available. Non-pe,m ted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Ctrf4iViEW DESIt i :TIM 4 OH N6tki <br /> State License# Expiration Date: <br /> Phone: (cell)tf/51.15.-4151 (office) U5 . 3P32.. V-PMS) <br /> I <br /> Mailing Address: 23S 111..or Wk1o8 (-OA-Q C : C>bT lfl �Jr�'I 2.1 .12 <br /> Contact Person: p`j•'{�, Mt C.1- J Applicant is: tra / Homeowner (Girds One) <br /> Email and/or Fax: 141\t 1C W-1.4v1J l? V i e1+�.bE 6tJ j . LOA_ n <br /> PROPERTY OWNER INFORMATION: <br /> Name: gor3L¢T • eelli 47C UM4... <br /> Phone(day): Le I2.• b*• 3435 <br /> Address: l t 3O OL-) CPYSTAL 13NY (a-C) S• City: VP-p...10 ZIP: f_de..7,aq I <br /> Email and/or Fax BE'[4•1. Sow KIELL, e Ea11/44411... i;OI1/44 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: SC.(9-ITP • ' %coJ CciVlt- DE51f*1 MOF' SIOv -S) <br /> Phone(day): q 2 . • 7- ,,rr <br /> Address: Qb(t D ' Ly/ O t a S SW TEi#ZCity:ELOaMII -- <br /> ZlP: / 42-O _ <br /> Email and/or Fax: c cOVr P(C — US . C O M <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> 0 New Construction Igi Single Family with 0 Accessory Bldg./Garage <br /> ❑Accessoryuildi ,meq {add attached garage Deck 0 Public Sewer <br /> _�I ❑ Single Family with Office/Commercial <br /> ❑Relocation f4 D j Phi $ ,A detached garage 0 Residence 0 Private Sewer <br /> g Other:(specify) 4 ia#O1*..0612- ❑ Multiple Family/Condo ,N Retaining Wall(s) <br /> WA'(-L. ❑Public 4-feet or greater 0 Public Water <br /> "Any earth movement may require 0 Commercial 0 Storage <br /> MCWD review&permits. Industrial 0 Warehouse 0 Private Well <br /> Minneheha Creek Watershed District(MCWD) 0 Other. (specify) ®Other(s._ ) <br /> 15320 Minnetonka Blvd PEUa0 <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wWw.minnehahacreek.org_ <br /> Estimated Construction Valuation(excluding land) <br /> $ 44-/ OW <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />