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T . <br /> CITY OF ORONO �, � <br /> BUILDING PERMIT APPLICATION �� �c� <br /> FOR NEW STRUCTURES OR ADDITIONS � <br /> �O�O Mailing Address: Permit number: �� '-� <br /> PO Box 66 ? <br /> Crystal Bay, MN 55323-0066 Date received: -�J— <br /> Street Address:� Received by: I� <br /> y�, G� 2750 Kelley Parkway Plan review fee: 3 3 g � <br /> `�'�ESH�R� Orono, MN 55356 d D/c�!-�}� <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 p nt) <br /> GENERAL INFORMATION: � �� <v"?`-� � <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATION: <br /> Name: ,� � -*- � <br /> State License# L . Expiration Date: / <br /> Phone: cell .1- 6 - S- S"' office <br /> Mailing Address: m�� � — Cit : �r�icc ZIP: <br /> _ <br /> Contact Person: , ; - - Applicant is� - Contracto��/ Homeowner (Circle One) <br /> Email and/or Fax: - � - � �_._-.. ---.-.--- <br /> � <br /> PROPERTY OWNER I FORMATION: <br /> Name: � c.,/c /�c_��so� <br /> Phone (day): G;�- �/,� - �ry" ��S� <br /> Address: _T�� � bfG�• ,� � City��� � ZIP: ��j�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER IN�FORMATION: <br /> Name: �`�.��v-�r �/ <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 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ddition 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 8�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.min nehahacreek.or <br /> $ x�' <br /> Estimated Construction Valuation (excluding land) ����D <br /> _ i <br /> , _ <br /> , , <br />