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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address:PO Box 66 Permit number: -.... / f - <br /> Crystal Bay,MN 55323-0066 Date received: / c2-Li--/Li <br /> ,� Streei Address:' <br /> Received by <br /> yes4 27613 Kelly Parkw y Plan review fee: • <br /> 1dkfs140-$ Orono,MN 55356 �r ! RQ/2Z /' <br /> Tutdl Fees. J <br /> Main: 952-249-4600 Fax: 052-249-4616 www.ci.orono.rnn.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: 1 S Df.-wNc 0 tr :.ane.N . ..1. , t�.J - <br /> Will.this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑Yes -No <br /> If yes,a spacial even(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-sile parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC NT INFQRMA ION: k1 <br /> Name: c,r6,,, .vti S CAI:fi 54.Cu -'�( <br /> Ci c n <br /> State License# Crze.5 31 q 6 1 Expiration Date: 3 S <br /> R' <br /> Phone: (cell) St, 2C, t,- c6 9(,"3 (Office) 36'3• `i3`� • 3 t <br /> Mailing Address: '51'r'f, pA.,..1, S-> . 20 'i(ACit :IAA,L•C A..a,.) ZIP: c 3s`l <br /> Cgntact Person: ._ c.1,-,,-, V az n �y �-- Applicant is: ontrac / Homeowner (circle one) <br /> Email and/or Fax: ',r,inn d Ca).- C ar c an- 'see.nn2 S . C6 ill <br /> PROPERTY OWNER INFQRMATION: <br /> Name: 0-7,.e n. IL LA A 1.-.640 e._ <br /> Phone(day): f./S'2. - 6 g'‘ '-'-)`)'f I J <br /> Address: • Its Of%: c• Ori3 , ( <br /> �u�l n.,�. City: Uro.-;C. ZIP: 5 35 <br /> Email and/or Fax j e$1 A r r•_nri:S Qc r.0 e (`�,�- c rvr ti:-:.I, C.;,n-t <br /> ARCHITECT/ENGINEER INFORMATt N: <br /> Name: 1-r V>e S .r-N,n\ AC . <br /> Phone(day): c'1 2.4. 1. (6. 3'3 02- <br /> Address: _ City: . ZIP: <br /> Email and/or Fax: .1,,,1 It t to 6c In r a r2 'k r.n A A P <br /> PROJECT INFORMATION: Descri tion of pro ect: _ <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> o New Construction ❑Single Family with 0 Residence <br /> ❑Addition attached garage ❑garage/Accessory Bldg. 0 Public Sewer` <br /> '[):Accessory Building 0 Single Family with 0 Deck A <br /> -0 Relocation detached garage 0 Office/Commercial El Private sewer f <br /> ❑Other:(specify) ❑Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage ❑Public ter -, <br /> "*Any earth movement may also require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. in industrial 0 Private Well <br /> Minnehaha Creek Watershed District(MOND) . Other:(specify) <br /> 18202 Minnetonka Blvd c'o.cc,.PI 12 <br /> Deephaven,MN 55391 Jl <br /> Phone: 952-471-0590 <br /> Fax: 952-471.0682 <br /> tw w.minnehahacreek.oro <br /> Estimated Construction Valuation(excluding land) $ /1 0 : 0 L C) <br />