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CITY OF ORONO <br /> BUILDING PERMIT APPLIC�4TION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���T Mailing Address: Ql g'���� <br /> `�O PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: --/ �� � <br /> � � StreetAddress:' Received by: <br /> �. . 2750 Kelley Parkway Plan review fee: � <br /> 19'�FSHo��c�' Orono, MN 55356 � <br /> Main: 952-249-4600 Total Fee: � S, � <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �jl�l,�'� ������ �,y�� ��. <br /> Wifl this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> lf 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 sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � � �c ' �'� ►�o� �� � �� � <br /> State License# �3� �,:��3 Expiration Date: �.� , ; <br /> Phone: cell � -�! -�"- / office <br /> Mailing Address: � �3 ,� ,� Cit : ��� f�7 ZIP: S� /; <br /> Contact Person: �r/vs � Applic nt is: �` oi ntra�tor� / Homeowner (Circle One) <br /> Email and/or Fax: ` C�r 5 Cprrs � '-�, u� <br /> PROPERTY OWNE INFOR AT ON: <br /> Name: ; - '; �� �;- <br /> Phone (day): - ,�_-� <br /> Address: City. Z�P. <br /> Email and/or Fax r���o�,,n���rr�l-f�mn G'fi <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑ Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ,�Office/Commercial <br /> ❑ Relocation , ( �+ e� detached garage ❑ Residence ❑ Private Sewer <br /> � Other: (specify) i�✓i'1�'�I `� ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �"� � `� ❑ Public 4-feet or greater ❑ Public Water <br /> *"Any earth movement may also require ,9-Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eCi ❑ Private Well <br /> 15320 Minnetonka Blvd � P �� ❑ Other(SpeCify) <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 ����� <br /> www.m i n n ehaha cree k.or <br /> � 3 2098 <br /> Estimated Construction Valuation (excluding land) $ �r ��U ��� � <br /> cmr oF oROWo <br /> Last Updated: January 2015 <br />