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f <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: j�Q/ , a <br /> 0 Y4 PO Box 6G Permit number: <br /> Crystal Bay,MN 55323-0066 Date received: / o7- �/ <br /> Sfreil Address:' Received by. A4� <br /> 1. L4' 2750 Kelley Parkes y Plan review fee: • <br /> Orono,MN 55356 ® J :� / <br /> ` * <br /> �kESµo -r" Totaffee Main: 952-249-4600f 4 <br /> Fax: 952-249-4616 www.ci.orono.mn.us / , 0 -7 . :J <br /> This application form must be completed in full and all required information m�t be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: !� <br /> Job Site Address: 1Oc {D�•)rJc V rLt:.0AEN 0 - <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? E Yes i;.-No <br /> If yes,a special event permit fs required with Police Department end 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 I APPLICANT INFQRMA ION: <br /> Name: (occur. '�C-m%t2.s' ^5 "cux.. tbr's <br /> State License# $C.531 c16 t Expiration Date: S- I <br /> Phone: (ce0) %S -- 2.tr. t" (6 9 6'3 (office) 16"3• `t 1`l • 31)t <br /> Mailing Address: '5t'1 IA 4_1, S'-1•. Qb •,5c.,(..•,5c.,(.. City:RA"LC L4 t.3 ZIP: Sac-1._.3,.1"--,Contact Person: ._.3,.1"--, .I az r t.i_ �— Applicant is: ontracfcl / Homeowner (circle one) <br /> ° <br /> Email and/or Fax: whn V C-61- cyr I Gn.. .set-^n�S . C.r/1 <br /> ,z <br /> PROPERTY OWNER INFORMATION: <br /> Name: . • ,z. t,;- V..tilit vt Loa <br /> Phone(day): 2 - 68'6 -Sl 4- I I – <br /> Address: les Or c,:�c. Oi G I G1 4. /61 <br /> Address: r.).,r, ZIP: 5 5 3S t <br /> Email and/or Fax k.k.(ILt 41rr•-nn:s ecwa C.- , net ct . Coto <br /> ARCHITECT!ENGINEER INFORMATI N: <br /> Name: ter Des .c)n \AC • <br /> c'I — <br /> Phone(day): 95-Z., -4={6- 3-4 <br /> Address: City: . ZIP: <br /> Email and/or Fax: i,,,..ic t b ti_- 60 h r_A rc:• `-k:"5 an ck 3 cis:,In . C_5;I"PROJECT INFORMATION: Description of pro ect: J <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction [ Single Family with 0 Residence <br /> ❑Addition Iattached garage {]garage!Accessory Bldg. ❑Public Sewer <br /> • Accessory Building 0 Single Family with 0 Deck <br /> ❑Relocation detached garage 0 Office/Commercial 0 Privatewer A <br /> ❑Other:(specify) 0I Multiple Family!Condo 0 Warehouse <br /> 0 Public 0 Storage 0 Public Miter <br /> ``*Any earth movement may also require 0 Commercial 0 Other(specify) - <br /> MCWD review&permits. i •• trial 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) G Other:(specify) <br /> 18202 Minnetonka Blvd cre-A) <br /> Deephaven,MN 55391 J <br /> Phone: 952-471-0590 <br /> Fax: 952.471.0682 <br /> wwdv,minnehahacreek.orq I <br /> Estimated Construction Valuation(excluding land) $ // 0 i 600 <br />