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• , \ol <br /> op , . <br /> . s <br /> i\0 <br /> Y 7q. 9 oz) <br /> CITY OF ORC)NO 1 q <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Kit4iik._tba... 9V-041) Mail ngg ddresPermit number: 6- (,fLsLJx 66 <br /> Crystal Bay, MN 55323-0066 Date received: ( �i/ i (�jStreet Address:' I Received by: ...74-b1:11/1C;4- <br /> 2750 Kelley Park,aye9 0 l 0050 •Ian review fee: iHOrono,MN 5535: la, - • # 4 <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: j3 gO p r-utue3 I,/16/ - <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 perking is available. Non-permitted events will not be allowed <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: StDAin.-vb , LL.G <br /> State License# $GS`t 315- Expiration Date: /._�/7 ?c// <br /> Phone: (cell) h 11 34 s'117.1 (office) !o 1-2-- 441-4060 <br /> Mailing Address: I3 r. 1,A t,- ci . City: tvv A- lq. A ZIP: ,c5-71 / <br /> Contact Person: c Y E 1.1 4-y41AF.fp rJ Applicant is: C tr Homeowner <br /> yy ° ract /� (mete one) <br /> Email and/or Fax: <br /> Syth� S�-OY\Z.wPo.i•Cu"^. <br /> PROPERTY OWNER INFORMATION: <br /> Name: 2 - t..1‘ EV•CA'BLE s► <br /> Phone(day): is 12-f51 -3D l e) <br /> Address: 3o IR f/l+i'Koiu Ave <br /> S City: M)tivegNi-l1 ZIP: Z-468 <br /> Email and/or Fax t_geLrPJic Q 4,/Ns AIL. Cat.__, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Ne..ia�..i gcsloswr•/ 'J( 6l, it, /PPP PLANA/IA-6- }4r 5/4_A/ <br /> Phone(day): 76 3-1g0- Boa 4- <br /> Address: q/oO &I-A,-,a , S7r• IUB I:1IC4 , City:8vr,Jl( ZIP: cc 441 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ._ N,� , -f-Q c ( < <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> New Construction Water Supply <br /> Addition ®Single Family with ❑Accessory Bldg./Garage <br /> attached garage ❑Deck <br /> ❑Accessory Building ❑ Single Family with 0 Office/Commercial Public Sewer <br /> ❑Relocation detached garage 41 Residence <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Retaining Well(s) <br /> ❑Private Sewer <br /> ❑Public 4-feet or greater 0 Public Water <br /> **Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse ®Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) 0 Other(specify) <br /> 16320 Minnetonka Blvd <br /> Minnetonka,MN 65345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0e82 <br /> _www,rgjng@hahecrkekoro <br /> Estimated Construction Valuation(excluding land) $ 1 / 171<l o a'c <br /> Last Updated: January2016 <br />