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�- <br /> . <br /> I � CITY OF ORONO <br /> . � BUILDING PE <br /> RMI <br /> T APPLICATION <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> �O Mailing Addiess: <br /> PO Box 66 Pe��t number: <br /> Crystal Bay,MN 55323-0066 Date rec�iVed: Z <br /> ,� StreetAddress:' ' • <br /> ����f � Orono, MN 5356 y ����� Plan reviewfee: �30 . $ <br /> kFSHO� <br /> Ma : 952-249-4600 Fax: 952-249�616 www.ci.orono.mn.us T��I Fee: <br /> T ' appNcation form must be completed in fuil and ali required infarmatio�m�stbe submi#t�d. <br /> incomplete applicatlons wtli be returned. (P/ease print) <br /> GENERAL �N RMATION: 3 � l, �js�� �� Q��� �� <br /> Job Site Adldr s: ,y�� S'S � <br /> Will this be rade of Homes, Remodelers Showcase Home or other Display Home� Yes No <br /> If yss,a special eve permJt is requiied wlth Police Departmern and Clty Counc!!approva/60 days prior to the e�nt. Shuttle bus service will be <br /> requiied uNess p nt demonstrates sufficient on-s/te parking is availeble. Non-pem►itted euents will not be allowed, <br /> CONTRACTpR ;APPLICANT INFORMATION: ,----- • <br /> Name: �/'A,� �/s �i Arr <br /> �1� <br /> State License# I Expiration Date: <br /> Phone: cel office <br /> Mailing Addr�ss: I � O � Ci : <br /> Contact Persbn: ' v ZIP: G <br /> A� T A � Applicant is: Contractor / omeowne <br /> Email and/or Fa :. �4 � A �� (Clrcle Ona) <br /> � <br /> PROPERTY D ER INFORMATION: <br /> Name: �A,�.r �/S ,/R�✓� <br /> Phone(day):I D Z <br /> Address: � ��/� : �� J <br /> Ci ZIP: � .�...�� <br /> Email and/or Fa �,c�,,� � � , �M <br /> ARCHITECT'/E GINEER INFORMATION: � <br /> Ph ne (day):I � �3 � 1� RG I �� L V� � I ��. � <br /> A d dress: E v�2 ci • LEPyqv�,,, Z�p: <br /> Email and/or�'a L GD E �- , Go� <br /> PROJECT INF RMATION: Descri tion of ro'ect: <br /> 1.Type of Pro ec 2.Proposed Use 3.Structure Type 4.Sewa e Dis <br /> ❑New Constrt�cti h �Nater Supp�aal& <br /> ❑Single Family with ❑Residence <br /> Addition attached ara e <br /> Accessory uil i g 9 9 ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Relocation� � ❑ Single Family with �Deck <br /> detached garage ❑Office/Commercial <br /> ❑Other:(speGfy) i ❑ Multiple Family/Condo ❑Warehouse �Pnvate Sewer <br /> ❑Public ❑Storage ❑Public Water <br /> ""Any earth m�ve ent may also require ❑Commercial ❑Other(specify) <br /> MCWD reviewi8 rmits. ❑ Industrial <br /> Minnehaha Cree�C W t rshed District(MCWD) ❑pther: (speCify) ❑P��ate Well <br /> 18202 Minnetonka BI p <br /> Deephaven,MN I553 �1 <br /> Phone: 952-4711059 !� <br /> Fax: 952�71-0 2 <br /> www.minnehaha ree . r <br /> Estimated Cohst ction Valuation (excluding land) $ ���Q o J d <br />