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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �D/ -UDSS� <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �'3��� <br /> StreetAddress:' Received by: <br /> S. � 2750 Kelley Parkway Plan review fee: � oZ0/�j-DO.SS� <br /> �`qkESH���G Orono, MN 55356 �i Jc-��,39 � -r`jj�� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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 INFORMATION: � .� <br /> Job Site Address: -�-j� � Gluc� �4�_��� ���L- <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,=� ��5 —�G:��> <br /> State License# �:;�Z��� (,�� Expiration Date: �y 3 I / 5 <br /> Phone: cell '1 �, �-�c � t� office �1 � �t Z5 �� � > � <br /> Mailing Address: j��Isd t � r.� �c� 'l�� Cit � � L ZIP: ^s ���j <br /> Contact Person: Jt,tr�� r� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: v4�u�� � A h5 Hvti�.S w�ti - c:c.� ✓�1 '7� � ��ti(� UC 5`� <br /> PROPERTY OWNER INFORMATION: ��I L� (� <br /> � ` ;�- ��� �, 7 0��. � �1� �� I��.�I 1� <br /> Name: itie�� <br /> Phone (day): �� 3 � Zc�c�o _ � <br /> Address: D Z � Cit : '1� � �O` `� ZIP: � �' � � > <br /> Email and/or Fax �:t�n,; �x-� �a f�o � �t vL�u� � �-�"vl <br /> ARCHITECT/ENGINEERINFORM TION: �I�` Z��.'"1� <br /> Name: �=��v i � ��5� �l I�L1�" ���a� -_ <br /> � � <br /> Phone (day): 7b 7 � S� - r�;� 7 �t�(�.-�-r z�P: � 6 �a,/ <br /> Address: ZG !c� L'�,`t� ,� ;'1, wr City: � -l <br /> Email and/or Fax: -�TTr�c;-7 - �(3 � 3 <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �New Construction �Single Family with �.Residence <br /> `�❑ Addition ' attached garage ❑ Garage/Accessory Bldg. � Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Oifice/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � Z�� L'� �' <br /> \ <br />