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v 1 <br /> CITY OF ORONO ->j g`l� �� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O • Mailing Address: Permit number: S�- U� � <br /> ��O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �'/� � <br /> StreetAddress:' Received by: c..., <br /> � � 2750 Kelle Parkwa <br /> ti�, G� Y Y Plan review fee: •�O`S'�l <br /> Orono, MN 55356 <br /> �� � a 3�� a� <br /> �kFSHo 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: , J <br /> Job Site Address: OZs !J �b► �1� � �A <br /> Will this be a Parade of Homes, Remo elers Showcase Home or other Display Home? ❑ Yes �f 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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC��T I OFjMAT N� <br /> Name: ( CS 1 <br /> State License# Expiration Date: 3�3 • <br /> Phone: cell . � Z. office $�• <br /> Mailing Address: �s� . � Cit : �l ZIP: S$3 <br /> Contact Person: Ap lica is: on / Homeowner (Circle One) <br /> Email and/or Fax: � l � ����•�11M <br /> PROPERTY OWNER INFO MATION: . /� 1 ,� <br /> Name: S��K f C M� IJOW1�� <br /> Phone(day): • <br /> Address: �d=� h • Cit : ZIP: s$3Sr <br /> Email and/or Fax ' . <br /> ARCHITECT I 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 8 <br /> Water Supply <br /> ❑ New Construction �'Single Family with �'�tesidence <br /> ddition attached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑Office/Commercial 87rivate 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) ❑Othef: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��� wV <br /> RECEIVED <br /> NOV 2 0 2015 <br /> CITY OF ORONO <br />