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1 <br /> � • <br /> r . GITY OF ORONO �, ���� <br /> BUILDING PERMIT APPLICATION /��$ <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O MailingAddress: Permit number: ���f ��� � (( �(�(� <br /> � � PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: �% _ _�`/ <br /> StreetAddress:' Received by: I�V <br /> a <br /> _—_ <br /> _ <br /> � 2750 Kelley Parkw ' � � 7 Plan review fee: �^ �� � I�U� <br /> �� L Orono, MN 55356 � Z 'y ���a( - -? <br /> �kfSHC)1� — ._.._-_....-------"_`. ._ . <br /> ___ �_ _ - <br /> ------- <br /> _._ _ <br /> Totai Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 � v:� ,� : _:, <br /> _... __. --. <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 INFORMATIO �- /� <br /> Job Site Address: � � ��j ,f'„C�'r��' C..,��y /��dy, Lj �� , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot er Disp y ome? Yes No <br /> lf yes,a special event permit is required with Police Department and City Counci!approva/60 days pn r to the event. Shutt/e bus service il be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATIO : <br /> Name: 5"%on e l .o.� �� L L�' <br /> State License# Expiration Date: <br /> Phone: cell � office � <br /> Mailing Address: % / �'�G/! rU p� ,G / Cit : � �, so ZIP: "- '" Z> <br /> Contact Person: � ,lus Applicant is: Contract r / Homeowner �c���one� <br /> Email and/or Fax: ��^��y,t� �.S�vti��u„ l�r�, L(�h� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Citv: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INF�TION: <br /> Name: a�"� �- • <br /> Phone(day): �j'Z ��d�- �/'?d �y <br /> Address: /y�'7l1 �3y���G-f?`7'Z�s L /t/ City: �l{�.�t- ZIP: �j 5���? <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ;�New Construction ❑ Single Family with �sidence <br /> ❑Addition attached o�� rage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Sino�^ " •k <br /> ❑ Relocation og e/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) G � /�� � tiouse <br /> ' l(� ' � e [�iPublic Water <br /> "*Any earth movement may also require ❑ ' � G�/J�� • " �PecifY) <br /> MCWD review S permits. ❑ I� � ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) � p, � �� <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> tivlv��v.,Ttir�neh,�hacr�eR��m <br /> Estimated Construction Valuation (excluding land) '° � ��� <br />