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. <br /> CITY OF ORONO �� <br /> � �� <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A'O Mailing Address: QIQ/ - 00,3 7 <br /> 'V PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: �� 2�� �� <br /> StreefAddress:' Received by: <br /> tiF � 2750 Kelley Parkway Plan review fee: S�7. (O <br /> tq �� Orono, MN 55356 �D/�� 0D3 ,� <br /> kES N��� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono �nn 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: � ` (C%v��� t " /� , ,� �. -1 • 1 ' ,J<��J��p <br /> Will this be a Parade of Homes, emodelers Showcase Home or other play me? 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 ill e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �1: � , �,�.� b�_ /_ ��y��.._ <br /> State License# Expiration Date: � <br /> Phone: (cell) �c i ��- . `i�i - In(`? CY�� (office) �1 L�� � -�`�-1� � -- ;, � �_ ��—'1 <br /> Mailing Address: ' �_ ( ,, (� A--:/�, �iV ': i E� b` CitY: C':',,,`; r� ZIP: � > ��� � (�- <br /> Contact Person: � r,; , �,_,;wF_ Applicant is: i^e"bntractor / Homeowner (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: `���(i �'L���i �<<o�,2 �('C�� � / ����f �L, <br /> Phone (day): � I? — '�c.'��t �(n�� � ,-� <br /> Address: �( Cit : � , -, ZIP: � � <br /> Email and/or Fax � : ,��y n � <br /> ��.�� v-�--, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> �New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑O�ce/Commercial �-Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> **Any earth movement may also require ❑Commercial [�.0ther(specify) <br /> MCWD review 8 permits. ❑ Industrial [�.-Rrivate Well <br /> Minnehaha Creek Watershed District(MCWD) [,]�Othe�: (spe ify) <br /> 18202 Minnetonka Blvd q��^�. ti t-�,� ����a'(����,, <br /> Deephaven,MN 55391 � � � ��� � <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wwwminnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � � Q Q�� <br /> , <br />