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• „Jar' <br /> +-0� <br /> CITY OF ORONO tl 1{ <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS ,1 <br /> �O` _ Mailing Address: Permit umber: C fbA --OW 7� <br /> IPO Box 66 <br /> Crystal Bay,MN 55323-0066 D received: /�'P -l.5 <br /> Street Address:' Received by: <br /> 2750 KelleyParkway:5-* Y Plan review fee: <br /> Orono,MN 55356 010/5-eve)7/ <br /> kfSHO� <br /> Total Fee: <br /> Main: 952-249-4600 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: 1 ' (� <br /> Job Site Address: 23'5 S O v e f U ; <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes lgNo <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 NFORMATIO : <br /> Y <br /> Name: r—L n o-,�,...ts ( ,-.. -rv,, 0 n <br /> State License# 6L S31 q 6( Expiration Date: 3/3t./d S <br /> Phone: (cell) ct s1.- 7..-1.1• g ct 6 3 (office) """-(, -(� 3)12, <br /> Mailing Address: Sty() A.:. S4. yo t,,,,-306 City: . ty')W.4,_.;,., ZIP: cc.351) <br /> Contact Person: -Jo1.,„ vc„!. Applicant is: Contra for / Homeowner (circle one) <br /> Email and/or Fax: `.01,,,, v •a c- 6 -- �c�n.- S, Co ivL <br /> PROPERTY OWNER INFOR TION: %.., \.' <br /> Name: c�rr` Qs '�" ,S r• 1e-A.Qckt. <br /> Phone(day): , .• <br /> Address: 1 5 0 ' -nip. ii- IMS City:6.06`prairtj. ZIP: 55341 <br /> Email and/or Fax bye, Q-4-s I @. 1,3:n s c.c.q. c:.e.r. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Rear �e s:c ,n \nC . <br /> Phone(day): CI SZ- 4-`1 k- 1- C Z ) 1 _ <br /> Address: 3-("i , 'Zto -- 5 . U3. City: ---\04-40.-r-, ZIP: 'S S3S`2_ <br /> Email and/or Fax: rh 1 k e- h e ‘,.e,1r.r cvc.o.. . -,n c) rL".d A-e S'.r . C.a.„„ <br /> PROJECT INFORMATION: Description of project: 1 <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ew Construction Water Supply <br /> + -f'I cVSingle Family with .Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. a'Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0 Deck <br /> ❑Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> ❑Other:(specify) 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public ❑Storage ❑Public Water <br /> **Any earth movement may also require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑Industrial drarivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fag: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation(excluding land) $ 'SOO 006 <br />