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. � / �9- �i-5 <br /> CITY OF ORONO �al <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �� - � <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —/ <br /> StreetAddress:' Received by: � <br /> y � 2750 Kelley Parkway Plan review fee: � � <br /> `� �,L Orono, MN 55356 p��►j l' / ��s S <br /> t9KESH�� Total Fee: 7 <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: � „���5' S j�-c�,Q� L.,,� � 'Q(Z G'�vt.�v '�'�'�-� - S��3 `� 1 <br /> Wil� this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �f No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��T� 1,� �S4��c�Z��.� �� �--F�K E �c.,����v jl2� ��L�.���.Q� L'j'� <br /> State License# (3� 3 y °� � 7 � Expiration Date: '��/�� � <br /> Phone: (cell) (;,i,� j�/7- �r� �� (office) lS�- y 7�-/--7J�t / <br /> Mailing Address: '3�� �„� s'�' City: �,C.�L t,v/� ZIP: :Ss � 3 1 <br /> Contact Person: :�,��.-t/Z �'�}-��`S�v--} Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ����2 `�k��Q�cw � L!�-tC� C���w%�,� �vt�p-d�C � C.��� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �c%C- e 2 �- N�e y �M ��d1� -� <br /> Phone (day): � 2 <br /> Address: �� (ev� S 1�2e1,,N� City: D��L�-�C� ZIP: SS'-3 q 1 <br /> Email and/or Fax � C C N � <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: A S fl���L�� :�� � ��5� � �v <br /> Phone (day): '�y 5 a- ,� co� j i v� <br /> Address: 7�d VZch�� �� Cit :�i�(�� yLJ(�� ZIP: �5 S 34c��' <br /> Email and/or Fax: L� ' D � t • � <br /> PROJECT INFORMATION: Description of pro�ect: <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. �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (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) $ �°� j, o c� U <br />