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��,(� . <br /> /- �,�,l� 1 �, <br /> � � CITY OF ORONO �/-' ' -'� �(P� <br /> �, � ��c� <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: -DlLS�l <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ��" �dZ'�3 <br /> StreetAddress:' Received by: � <br /> � �' 2750 Kelte Parkwa � D �J�p• Q�f � <br /> ti�, G` Y Y Plan review fee: <br /> Orono, MN 55356 / - <br /> `qkESH��� 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: f ,,,� �J <br /> Job Site Address: �J"� ��a=C. S l� ���< ( � ` � `�� � <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 requrred with Police Department and City Council approva!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/APP�ICANT INFORMATION: <br /> Name: (a�r�y ra �tow�r5 <br /> State License# �2�(.5°� Expiration Date: <br /> Phone: cell (0 1�- vl K i - `t�6 � office <br /> Mailing Address: �%� � L SE�, �'��+�� Hw Cit : �c( �� G��� �' ZIP: .S S � � <br /> Contact Person: ��� � ff , Applicant is: rac� / Hom owner (Circle One) <br /> Email and/or Fax: ��f I�����y�a I���ti.�=� c��-Y�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: (. p v�y f � l�o v��c �-. <br /> Phone (day): <br /> Address: ^�� ZIP: <br /> Email and/or Fax � �� Q � <br /> U• <br /> ARCHITECT/ENGINEER INFORMATION: � � � � �--�g-`_ <br /> j , . <br /> Name: �C� � Lo��v.� l �� ^ <br /> Phone (day): -�? � - `�S � � �� <br /> Address: ZIP: <br /> Email and/or Fax: �Z� <br /> PROJECT INFORMATION: Description of project: ��I <br /> 1.Type of Project 2. Pr�� �ed Use 3. Structure Type 4.Sewage Disposal 8 <br /> ��� Water Supply <br /> �ew Construction imity with lid"Residence <br /> ❑Addition � �garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building 2,�• � �ily with ❑ Deck <br /> ❑ Relocation ✓ 3 arage ❑ Office/Commercial Private Sewer <br /> ❑ Other: (specify) _ -� �� � ," , � �y/Condo ❑Warehouse <br /> 2� �(� ❑ Storage ❑ Public Water <br /> **Any earth movement i 4� � ❑ Other(specify) <br /> MCWD review&permits. Private Well <br /> Minnehaha Creek Watershed L �� ^,� ;eCify) <br /> 18202 Minnetonka Blvd �-U� <br /> Deephaven, MN 55391 Cl <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ���', �`'��� <br /> � <br />