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. � ,� � ,�,,� � <br /> CITY OF ORONO � ��� <br /> � BUILDING PERMIT APPLICATION � ��� <br /> � ��� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: � �j ��0 �`3 <br /> PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: "( � �� <br /> StreetAddress:' Received by: � <br /> � �' 2750 Kelle Parkwa 3 <br /> y�, G Y Y Plan review fee: <br /> t9kFSHo��` Orono, MN 55356 apj3�d��$y <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: �, '/� -t C� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servic ill be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT INFORMATION: <br /> Name: ��-� I�'"t���� ��c. <br /> State License# ����� �c�y B�p�,z;yy Expiration Date: � - /5— <br /> Phone: cell � �- i �_q -95- office) G�(.� - 7�� �r�s y'�s-- <br /> Mailing Address: 1 O ra �'� Cit : ti z-�-r�F+-�. ZIP: <br /> Contact Person: �G� Applicant is: Contracfor y Homeowner (Circle One) <br /> Email and/or Fax: ` ,� ,,,� ; ,7.�� �s F-a h�f . 5�z <br /> PROPERTY OWNER INFORMATION: <br /> ►vame: P<< Jc �-�;��„� P�-t-c �so� <br /> Phone (day): ��- ° S <br /> Address: �� vr Cit : ZIP: � <br /> Email and/or Fax .(,gyV� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � 2. ���k�'�-rc�~rK r t_ <br /> Phone (day): <br /> Address: City: ZIP: <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 & <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 ❑ 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&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 /> $ � i <br /> Estimated Construction Valuation (excluding land) �� � � <br /> � <br />