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, � z � _ �� <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION Q �� �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � <br /> �O� Mailing Address: Permit number: p?D/ — �3S <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �- �,3 -/ <br /> Street Address:� Received by: ?"- <br /> y � 2750 Kelley Parkway Plan review fee: � 8"t� �� <br /> Ft,y ��,�' Orono, MN 55356 �Q/c�!_ GO�S <br /> kESH� <br /> 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: c3 LS ����;�;� �y�zc;,-��J �=F� c���z, ,�1,� ���`-�� -`1 1► � <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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '�t2�=�'�`. �����o;'� �-lc��L1�=5 . ��.c� <br /> State License# �K- �,�Z3 Z Expiration Date: 03 - Z�«. <br /> Phone: cell . �2-�,,-' - �2���Z�. office �� z - 7��� - i l <br /> Mailing Address: Z.Z-7 �hY-i.1av�� l�.J�t"�=� Cit : c1�;N/� ZIP: S� Z <br /> Contact Person: P��'R,�ll� �3 CcaN�1� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: b��-,� ; z c. ��-��,+1��•�s��:� o�y1�.:.� cr�crv� <br /> PROPERTY OWNER INFO MATION: <br /> Name: T t�i�t- '��taAtJO�� <br /> Phone (day): �;,;�€ �5Z - `�3-- (c :� <br /> Address: �3L� x��,�-� ��i�c' G-L�Ps'7 City: ��=rx�c� ZIP: S r;���''t L -��1 l� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: To�r� 1�Ai�1 pE y,�1�C:� N= �>F TCh,2 f�-�-k-itTE<=�5 <br /> Phone (day): �,l�z l � Z<' - Zc'�m r�-r- �Z-T <br /> Address: Z-�4� u.3 3Q-4 ��• City:M►NN�A���S ZIP: `�,jS'41 �� <br /> Email and/or Fax: ��p.�.�p—�,�1� W}{,�. C T�2 t��liT-�.�-T.� .c�c�'�'1 �l�Z '`��t--Zr=�-� <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of 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 detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other: (specify) �rT"���- P�'� ❑ 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) �pther: (speCify) <br /> 18202 Minnetonka Blvd B�,L �7�y��,. <br /> Deephaven, MN 55391 ,�..e�v� �p,y` � <br /> Phone: 952-471-0590 ��.t��, <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or �u�'�` <br /> Estimated Construction Valuation (excluding land) $ 7���j���� <br />