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RECEIVED <br /> City of Orono x�� �0 AUG 1 8 2015 <br /> $il <br /> }t el <br /> - <br /> -b‘Permit Appli a n cn OF ORONO <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p7�/5-b/O 471-6 <br /> �QA> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 57.-M--15 <br /> Street Address:' (� Received by: M <br /> 2750 Kelley Parkway ui��1( Plan review fee: IC? S/S/5453 <br /> 1104c:,• Orono, MN 55356 <br /> 41cESHOR-' Main: 952-249-4600 Total Fee: a0/S-b/Z(iS <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: X35 O 0 t,v� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ 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 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:' p <br /> Name: l 'n rA.,, \Gw.�e.c 5A-r- v..C7t 1(7 Y‘ <br /> State License# gC 5 t 9 61 Expiration Date: It-4-/- <br /> Phone: (cell) 'KZ.- - Z()I- q9.�3 (office) (,3 - }cj - --4- k 1 <br /> Mailing Address: Qo (70 306 1 'St S) Nle,. Si City: ,(r'Qc,_;-,, ZIP: S'S ,S ) <br /> Contact Person: c j,‘r, VO--v. V Applicant is: onrac , / Homeowner (Circle One) <br /> Email and/or Fax: ``c,1.,\ , 6 r A-c,c, _ Q 5 , �,�,,,� <br /> J � J <br /> PROPERTY OWNER INFORMATION: n 1 <br /> Name: .....0 q- Kee e-C-c:c‘- Br-C.v,e_VO S-+ <br /> Phone (day): 6 i l - `4 <br /> Address: .o Lr, 0 City: -0111„, ,.. ZIP: „� '64 <br /> Email and/or Fax cebecc.e . Br-en2. 4cSk- � e..v . c�.:-� 0r <br /> ARCHITECT/ENGINEER INFORMATION <br /> Name: Z r e S,C e'N r\L <br /> Phone (day): ckSZ_ -4"-k - }-.c Z <br /> Address: 3t{9 b w . 22.0 ' i Si-- City: -or•io.T ZIP: 5 S W2.- <br /> Email <br /> 5ZEmail and/or Fax: tvoc-e_b e..„ e_�,r d t-04..--c+...;,-.1 o.,.. . <le s, ,,p . C b N„. <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> CEr-New Construction cEr`6ingle Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage El Deck 'ublic Sewer <br /> ❑Accessory Building El Single Family with ❑ Office/Commercial <br /> El Relocation detached garage cl@esidence ❑ Private Sewer <br /> El Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater 0 Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ['Warehouse F ivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) El Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ j 2-c) C)O <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />