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�,�s . <br /> , - ^ � CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDtTIONS <br /> Mailing Address: Pe�mit num6er � b{j Z�". <br /> �-�� PO Box 66 ��� <br /> 0 Crystal Bay, MN 55323-0066 Date received: <br /> - StreetAddress:' "Received by: i <br /> y� • �� 2750 Kelley Parkway `� ,�-Z� S!-OOZ� <br /> �.- Gti Plan;review fees <br /> �, Orono, MN 55356 <br /> t��ES Ef O�' <br /> �°Total Fee: � <br /> Main: 952-249-4600 � Fax: 952-249-4616 www.ci.orono mn us � <br /> Tfiisappiication":form must.be completed<in�fulfand all required�iriformation;must"be submitted: <br /> incomplete applications will be returned (Please print) i <br /> GENER� INFORMATION: <br /> Job Site ddress: � <br /> Wiil this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> !f yes,a specia/event permit is required with Police Department and Cify Council approva/60 days prior to the event Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events wlll not be al/owed. <br /> CONTRACTOR/APPLICAN R TION: <br /> Name: L1�� <br /> State License# Expiration D te: <br /> Phone: cell • • office • � <br /> Mailing Address: Cit : ' P: I <br /> Contact Person: • �s pplicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: � i <br /> PROPERTY OWNER INFORM�TI N: <br /> Name: <br /> Phone(day): ` � <br /> Address: Ci : iVJ ZIP: +� 3 <br /> Email and/or Fax � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: SfA NM 'E ipl S CD w f V1h G=0 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. �ublic 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 aiso require ❑Commercial ❑ Other(specify) � <br /> MCWD review&permits. ❑ Industrial . ❑Private Well j <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) i <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 I <br /> Fax: 952-471-0682 I <br /> .minnehahacreek or I <br /> Estimated Construction Valuation (excluding land) � ��J�/ ��v — I <br /> I� <br /> i <br /> I <br /> � � <br /> . ii <br /> I � <br />