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2 <br /> � . : . <br /> � � CITY OF ORONO � <br /> � �� �a , <br /> BUILDING PERMIT APPLICATION 1.� <br /> FOR NEW STRUCTURES OR ADDITIONS � <br /> �O ` O Mailing Address: Permit number: % '- ' `-4 <br /> 1�� PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: Z� s`-� -�-'� ���`t(c; <br /> Street Address:' _ Received by: �{-� <br /> a ,, ,-- _ " <br /> ti�, �� 2750 Kelley Parkway����;(+{ -�.{:�q�� Plan review fee: �'�+7 . 1 � �{c'c— '�i�`�• <br /> Orono, MN 55356 <br /> C�kESHv�� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 v��ww_ci�c�!on.�:���n �,,s <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: 'N �j�J� y�.� �/ �" �27 J� � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay Ho e? Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the e ent. 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 INFORMATIO � L LC <br /> Name: �10� 2 / �r. i <br /> State License# Expiration Date: �3 ' <br /> Phone: cell p office � � <br /> Mailing Address: % - / �'�G'/! TU� G / Cit : � � to ZIP: ' � 1> <br /> Contact Person: � G�a Applicant is: Contract r / Homeowner (Circle One) <br /> Email and/or Fax: �^�fy,v �Sr'o�,�Luv lHh, L(J� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFO/.�TION: <br /> Name: o�,,,� ti- • <br /> Phone (day): /Z ���_ y?d �j" <br /> Address: /y � / �L�G/,TD H L /i Cit : � �- ZIP: S�—��j <br /> Email and/or Fax: <br /> PROJECT INFC��" cription of pro�ect: <br /> 1. Type of p� 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ,�c N� � ❑ Single Family with Residence <br /> ❑Ad� �L��. I (� attached garage �Garage/Accessory Bldg. �Public Sewer <br /> ❑Acc, / ��, ❑ Single Family with ❑ Deck <br /> ❑ Relo� � (� �(� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other � n _'n �Multiple Family/Condo ❑ Warehouse <br /> / /"�� 1 � Public ❑ Storage �iPublic Water <br /> "*Any eart. � �1.�" � Commercial ❑ Other(specify) <br /> MCWD revl �,(�,6� � � ndustrial ❑ Private Well <br /> MinnehahaCr, (� v��.(,(�. � � Other. (specify) <br /> 18202 Minneto� �G �� <br /> Deephaven,MN �_( <br /> Phone: 952-471- ��� <br /> Fax: 952-471-06� <br /> �N�w��v mirnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ � �� <br />