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. CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �Oy a� Mailing Address: Permit number: 20 I S � �C �/ <br /> 1�� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 1 � Z3 "'I S <br /> � Street Address:' �'—� b � �� ,• <br /> ��, G� 2750 Kelley Parkway ����O�� Plan review fee: r� � q a <br /> �9KESH�t''� Orono, MN 55356 �� <br /> Tota ee: <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 appiications will be returned. (Please print) <br /> GENERAL INFORMATION: n <br /> Job Site Address: � ej , ,� �- �,� ; v ? rl� r4�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 Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates suffcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I MATION: <br /> Name: ' L t <br /> State License# � Q Expiration Date: 3 3 O <br /> Phone: cell - - s' office S - s'OS 3 <br /> Mailing Address: G Cit � ;,,,,.�r,..Q�,, ZIP: $' <br /> Contact Person: c/�4,.'e T'<<.c. s Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: $TjGcJ,� O � �o o �..rlF �:LD�«� s .Go ra, <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��To.�.� 6,�aoiC. Dc v . C L C' , <br /> Phone (day): QS .? � S Y�`- G.S'S�3. <br /> Address: G�/ ? B� � � �� City: �yj.��,�.� Tw�..z�P: ss 3 y3, <br /> Email and/or Fax LSTC. c1 G � 6� Lss ao .s „ v;L.�C,c.t • la �-�-- - <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: " <br /> Phone (day): 2 - 3 V - p <br /> Address: // Cit : ,�,,,..� Tv.�.,r�z�P: s s 3 y <br /> Email and/or Fax: " v � '� c K-i .G �--� <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 � Single Family with ❑ Deck <br /> ❑ Relocation a hed arage ❑ 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 ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ 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) � 3� Q a Q � , <br />