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� y <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: F � !� `�� ..,. ' <br /> �L�.l� . PO Box 66 <br /> Pe�mit number . ,"G���r�.�..;, <br /> �' Crystal Bay, MN 55323-0066 :-Dafe received: —3 �� <br /> ; .. , <:.: <br /> x,<..;.:. <br /> StreefAddress:' s;Received b: ��� <br /> `�, `. . .,�� . 2750 Kelley Parkw ?p�4��v� : ; $�'1 �� <br /> �-. : , -. ;�.. "Vz�::PI `fee: � � <br /> l, :. �.�.. ;�;� Orono,MN 55356 f�>�..;>,;; <br /> "��ssf[o� `�Total Fee: � <br /> Main: 952-249-4600 = Fax: 952-249-4616 www.ci.orono.mn.us �;:;;.." <br /> �. ......:: <br /> Tfiis'application:fo�m'must.be�completed:in�:full:and:ali requir'e"d�irifo.rmation:must'be'subrriitted: <br /> Incomplete applicationsiwill be returned: (Please print) ' <br /> GENE� INFORMATION: ���� <br /> Job Site ddress: W <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes o <br /> If yes,a special event permif is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wili be <br /> required un/ess applicant demonstrates su�cient on-sife parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAN R TION: • a C <br /> �Jame: <br /> State License# Expiration D te: <br /> Phone: cell � • office � � <br /> Mailing Address: Cit : ' 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): � � • � <br /> Address: Cit : �1N ZIP: � 3 <br /> Email and/or Fax ' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �._� :�: � ip�� D w 1 W�k �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 Bidg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation etached garage ❑ Office/Commercial ❑Private Sewer <br /> ❑ Other: (specify) �ultiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> *"`Any e�rth movement may also raquire ❑ Commercial ❑ Other(specify) private Well <br /> MCWD review&permits. ❑ Industrial , � <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef: (speCify) <br /> 18202 Minnetonka Bivd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.mi neha a eek or <br /> � �� �-��---- <br /> Estimated Construction Valuation (excluding land) <br /> 3z� '�"� � <br /> , 3 I <br />