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1 <br /> t � � <br /> ` <br /> CITY OF ORONO � / � <br /> � <br /> b7 � <br /> BUILDING PERMIT APPLICATION / <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: '7= 0 l� � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066,^ . Date received: / <br /> J"`" i1 <br /> a y StreetAddress:' J�' �� �' Received by: /��ry /L(l' <br /> y�, G� 2750 Kelley Parkway /b Plan review fee:� / ,� <br /> �qk�SHo��. Orono, MN 55356 �O/7—O/O�(� <br /> Main: 952-249-4600 Total Fee: <br /> 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: � <br /> Will this be a Parade of Ho es, Remodelers Showcase Home or other Di play 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. Shutt/e bus service il be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP ICANT INFORMAT N: <br /> Name: � Q <br /> State License# Expiratio Date: <br /> Phone: cell - office �' - <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: . <br /> PROPERTY OWNER INF RMATION: <br /> Name: � <br /> Phone (day): �. -- � iI r� <br /> Address: . Cit : ZIP: 5� 7�/ <br /> Email and/or Fax <br /> ARCHITECT/ENGI�IE�INF�ORMATION: <br /> Name: � ��(� <br /> Phone (day): ^ _ p <br /> Address: //�lb Cit : ZIP: C�Z <br /> Email and/or Fax: <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 ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage �2esidence �'rivate Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo C]�etaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(speCify) ❑Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � Q D <br /> SEP Z01/ <br /> I I � <br /> Last Updated: January 2016 CITY OF ORONO <br />