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CITY OF ORONO <br /> • n <br /> BUILDING PERMIT APPLICATION �1 <br /> FOR NEW STRUCTURES OR ADDITIONS 10 4•KO <br /> OAT Mailing Address: Permit number: 0 A <br /> y�'O PO Box 66 �`- <br /> Crystal Bay, MN 55323-0066 Date received: ,r <br /> Street Address:' <br /> Received by: <br /> 2750 <br /> �� � 2750 Kelley Parkway Plan review fee: (3 7/,3 2--Jt�kESH���G Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: � ��� ac)-1C:> <br /> Fax: 952-249-4616 www.ci.orono.mn.us ExroW Rn IALANWA4+,,, rri6lux6 Ye.3- <br /> This application form must be completed in full and all required information mustbb submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 7.17 00 k_z ?Z;,-..) - _.`‘ C <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 servicei�411 Se <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION:i <br /> Name: C__.--,1C-\c,,J_� C._c. ,'r2<c-,a\-1c,.J <br /> State License# •L,-k7 cY-.,S Expiration Date: :,13i t, ,(� <br /> Phone: (cell) (eS\ _ - 9,..e,_- 9l3_ 3c..z.:--e_ (office) i..5\_3 - - .....L.,7__ <br /> Mailing Address: -7 L. { _e_,-„�,h.l, .k.b , Cit :-�..C(���,.yl.-t ZIP: �31, ' <br /> Contact Person: ..y^-) <'"1-y�� `N-- Applicant is: (ontractoi. / Homeowner (Circle One) <br /> Email and/or Fax: f-5c : � ioc.e,; o,-,sw� N:,:,,,. , ,::-., <br /> PROPERTY OWNER INFORMATION: <br /> Name: kJ * A,->:14..-LA, \-\c, -.......--) <br /> Phone (day): riST_- 72z-c.) t-i-`-c okk <br /> Address: t`toi'S`'i /"u. ,..4‘.. Q,.,.i City: &IEA, ?r ZIP:` 5341 <br /> Email and/or Fax c,irw.e..\vat, 0 Y..s,,,V. C.:-c;e^-•••-- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: M-stL-i--_ Et1.,,,- (. ('_l-v- 6 _) <br /> Phone (day): (1.:=.p.._- 7te - 7 1`'-Z-_ <br /> Address: City: r;r,,--i ZIP: <br /> Email and/or Fax: ,,;IC.�l. 0 h f i✓\v- ,,,„C1;„.,,.,,,r,c@-P,:_,-y. c4,,,, <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> New Construction Water Supply <br /> (� Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck <br /> Building ❑ Public Sewer <br /> ❑ Accessory ❑ Single Family with 0Office/Commercial <br /> ❑ Relocation detached garage 0 Residence (Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo 0 Retaining Wali(s) <br /> ❑ Public 4-feet or greater 0 Public Water <br /> *"Any earth movement may also require 0 Commercial 0 Storage <br /> MCWD review&permits. ❑ Industrial 0 Warehouse [g Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) 0 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) BASO , 000 <br /> Last Updated: January 2015 <br />