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\ ______-- <br /> ` ' . �� <br /> . • `� <br /> CITY OF ORONO � .�� <br /> �5z �� <br /> BUILDING PERMIT �4PPLICATION <br /> FOR NEW STRUCTURE� OR ADDITIONS <br /> �? Mailing Address: Permit number .. <br /> �� PO Box 66 �I � <br /> - �V <br /> 0 Crystal Bay, MN 55323-0066 ;Date received: —3 � <br /> Streef Address:' Received b ` ��� <br /> y ti 2750 Kelley Parkw ZD���(�Z�"'js PI 'fee: � , g c1 �1�� <br /> ``� ' � Orono, MN 55356 <br /> �"��ssf�o�`'�+ aTotal Fee: D�\y <br /> Main: 952-249-4600 = Fax: 952-249-4616 www.ci.orono.mn.us <br /> Tfiis appiication::form must.be completed;in full;and all requiretl;�information;musf'be'subrriitted; <br /> Incomplete applications will`be returned: (Please print) <br /> GENER� INFORMATION: <br /> Job Site ddress: W L �1 V'�� <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 Police Department and City Council approval 60 days prior fo fhe event. Shutt/e bus service will be <br /> required unless applicant demonstrates suKicient on-site parking is available. Non-permitted events will not be adowed. <br /> CONTRACTOR/APPLICAN R TION: - <br /> Name: =a� <br /> State License# Expiration D te: <br /> Phone: cell � " office • • <br /> Mailing Address: Cit : ' P: <br /> Contact Person: i E pplicant is: ontrac o / Homeowner (Circle One) � <br /> Email and/or Fax: � � <br /> PROPERTY OWNER INFOR�i N: <br /> Name: <br /> Phone (day): � Cit : iVJ IA ZIP: +J^ 3 <br /> Address: <br /> Email and/or Fax ' <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: SA NM 'E i01 S CD w 1 V1h �T�t!`.. <br /> Phone (day): City: ZIP: I <br /> Address: <br /> Email and/or Fax: <br /> PROJECT INF�RMATION: 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. �blic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation ,�etached garage ❑ O�ce/Commercial ❑Private Sewer <br /> ❑ Other: (specify) ll�J Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> "'�.ny ear:n movemen4 ma;als� rea,uirc ❑ Commarcial � Other(specify) <br /> MCWD review&permits. ❑ Industrial , ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) <br /> 18202 Minnetonka Bivd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � �� L��v.-._--- <br /> i <br /> , , <br /> � � <br /> I <br />