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, e CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: � Permit number: �` �� % `` ` � �� ���'`1 <br /> �- �TO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � ' '��'� <br /> F�eceived by,.__.___._ ' %� <br /> StreetAddress:' - -- — —' <br /> yF � 2750 Kelley Parkway` � i `� ' �' �' Ptan review fee: �•� > ` � ^ <br /> �' _. ;: <br /> � �L Orono, MN 55356 t `t- _ —___ __ __ ____ <br /> '�xEsxo� 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 sub itted. <br /> Incomplete applications wiil be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � -:� � L ���`'��-�C= ��'C-�"� ��` <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Counci/approva!60 days prior to the event. 5huttle 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: �`��`a r ��C'� Y� � ��:`!� �,�f r"�-'`i <br /> State License# r,' • � � 1-•��; C Expiration Date: �` �a ,r � �.f 1 �- <br /> Phone: ce I "-�" " `=: � office <br /> Mailing Address: �' 4 '; Y'� r;� (' -��'r �' ���� Cit .,'��-��__ rr � ;-,�_l ZIP: <br /> i. <br /> Contact Person: � ��-�� ��,�-r� �=�-Y�.r Applicant is: t ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ���Y���� �;. �j i_"L (t����t� �Y if� 'I,i_.��r(�t`u ,(����y�,,,� � ��� _ _,: <br /> PROPERTY OWNER INFORMATION: <br /> r:� i� `� <br /> Name: �'L.,C�Z '�' �' �f'l�.�� �:., �- ! <br /> Phone (day): <br /> Address: r � <br /> C 1�` � Pf��,l,'��'j �•::����-��- City.:.�; f��t� ._ ZIP: <br /> Email andlor Fax � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: r/ �-,(. i� �;��<.y` j.j' �:'d.t.i)(';� 5 <br /> Phone (day): �� <br /> Address �� i �h� �' City: ZIP: <br /> Email and/or Fax: —��� p' <br /> r <br /> �"k J� d.��l r�-1 d.ul <br /> PROJECT INFORMATION: Description of project: ��''��'�'������ d�' -"�-� '=�'� � �`��� 1 �:—.�-''�"�'-�'``- � �-�``�'-�- ,�- `�- F ��-%�`���" <br /> 1.Type of Project 2. Proposed Use I 3. Structure Ty e 4. Sewage Disposal 8 <br /> Water Suppty <br /> �,N ew Construction ❑ Single Family with I ❑ Residence <br /> �Addition attached garage ❑ Garage/Accessory Btdg. ❑ Public Sewer <br /> Accessory Buiiding ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commerciai ❑ 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) ❑ Othef: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � �R� �-C,,�.,- <br />