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� � , CITY OF ORONO �c�, 5 J <br /> �� � 3 <br /> BUILDING PERMIT APPLIC `"� <br /> ATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���0 Mailing Address: a�l���� 9 <br /> PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-006 r Date received: /— �� -/`j <br /> ..� Street Address:' � / _R�e.iyed by: }'I� <br /> �� � 2750 Kelley Parkway �� f . G�� <br /> � Plan review fee: / , <br /> l.q��s�ogti�' Orono, MN 55356 <br /> ---__._ �; <br /> -- ---- <br /> __.___.-- <br /> otal Fee: �r�—� <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 mu e submitte '� <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �C 0 j y ��°�x� ' • 7//��g�'T'a,�,, <br /> � it e� . J <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> /f 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 un/ess applicant demonstrates sufficient on-sife parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I MATION: <br /> Name: - � t <br /> State License# � p Expiration Date: 3 3 � <br /> Phone: cell - - S office S s'OS 3 <br /> Mailing Address: Cit � ` r-,..�,,` ZIP: SS <br /> .Nw� <br /> Contact Person: G/f w•��T<<c s Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: _��v,� � � ea ���,/� � p�� s , o� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �To.�.� t3,d.aeif'- b� v C L C' <br /> Phone (day): QS � � S y� —l�,s S� , <br /> Address G � � Cit : �,V,,.�,�,C To..,,7.,ZIP: SS 3,�,� <br /> Email and/or Fax 15Tc �� � r C� L�aa .i • �,"[,,p��a �a ....` <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ^ <br /> Phone (day): Z. - g u � � <br /> Address: // Cit : .s...,,..� 7-v.,.,r,z�P: s 3 y <br /> Email and/or Fax: -' v Q '� c w s . ...---. <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> New Construction ❑ Single Family with Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. Public Sewer <br /> ❑Accessory Building 0 Single Family with ❑ Deck <br /> ❑ Relocation � ched qarage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ulti le Famil /Condo ❑ Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> ��Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial <br /> Minnehaha Creek Watershed District MCWD ❑ Private Well <br /> ( ) ❑ Other. (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) $ �j� Q d Q Q , <br />