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♦ ., <br /> � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: 'Pe�mit number <br /> : ����r�..:� . <br /> '�O.�T' PO Box 66 . <br /> °�� Crystal Bay, MN 55323-0066 Date received. —3 � <br /> �:.<";,:::. <br /> StreetAddress:' �.Received b: ��� <br /> �.. •,� 2750 Kelley Parkw Zp�4�(�Z<j5�PI '"• ;fee: , g� �� <br /> �� � ' �' ��` Orono,MN 55356 ' � <br /> , j . � �<.:;,;; . '� <br /> `��Esfco�' '�Total Fee:. <br /> Main: 952-249-4600 � Fax: 952-249-4616 www.ci.orono.mn.us ��:;;.;.', <br /> Tfiis'application:form'must.be�completediin full;"and:alFrequired�iriformation:mu"st'be subrriitted: <br /> Incomplete applications;will be returned: (Please print) ' <br /> GENER INFORMATION: <br /> Job Site�ddress: W ��1 W� <br /> Wiil this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes o <br /> If yes,a special event permit Is required with Podce Department and City Councll approva160 days prior to the event. Shuttle bus se�vice will be <br /> required un/ess applicant demonsfrates su�cient on-site parking Is availab/e. Non-permitfed events will not be allowed. <br /> CONTRACTOR/APPLICAN R TION: • <br /> Name: Za C' <br /> State License# Expiration D te: <br /> Phone: cell • ` office � • <br /> Mailing Address: Ci : ' P: <br /> Contact Person: : E pplicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: � � <br /> PROPERTY OWNER INFORM�TI N: <br /> Name: <br /> Phone(day): ` � Ci : iVJ ZIP: �� 3 <br /> Address: <br /> Email and/or Fax ' � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: c�• � �e ip1 'S CD w f W�k G.TO d�•. <br /> Phone (day): � <br /> Address: City: ZIP: <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 /> ew Construction ❑ Single Family with esidence �/ <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation �etached garage ❑ Office/Commercial ❑Private Sewer <br /> ❑Other: (specify) Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage Public Water <br /> **Any earih movement may also r�quira ❑ Commercial �Other(specify) <br /> MCWD review&permits. ❑ Industrial , ❑Private We�l <br /> Mlnnehaha Creek Watershed Distrlct(MCWD) ❑Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> .m( eh hacreek or <br /> Estimated Construction Valuation (excluding land) � `��� �� <br /> �z� ��� � <br /> 3 I <br />