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. <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ;��(l— ��,,,. � <br /> j�.,0,�. PO Box 66 Permit number: �-�t� <br /> � Crystal Bay, MN 55323-0066 Qate received: -/ `�� ' <br /> � O y9, O ... . ., <br /> �I ��,�'" � � Received by: l2� -� l��C �f-��a/�i!� �ylYlC <br /> 1,a "'�{� ` �,� Street Address:� ? � <br /> �\, <br /> i' � �,,'y,� Gti� 2750 Kelley Parkway ���C������ �P an�review fee: I< o� f • <br /> 5� «'�g� Orono, MN 55356 <br /> �`?jtESHo <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 applic tions will e returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <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 evenf. Shuttle bus service will be <br /> required unless applicant demonstrates suffrcient on-site parking is ailable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA I FO M ION �) <br /> Name: <br /> .� I � <br /> State License# Expiration Date: <br /> Phone: � office cell <br /> Mailing Address: � City: ' ZIP: <br /> Contact Person: Appficant is: ontrac o / omeowner (Circle One) <br /> Email andbr Fax: (� <br /> ` <br /> PROPERTY OWNER INF , ATION: <br /> Name: <br /> Phone(ciay): .. <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN ER FORMATION: <br /> Name: � <br /> Phone(day): _ <br /> Address: Cit : ZIP: f I <br /> Email and/or Fax: ' <br /> PROJECT INFORMATION; <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> , � Water Supply <br /> Q New Construction �ingle Family with �esidence <br /> �' Addition �T ��� '��m�'�(� � � attached garage ❑ Garage/Accessory Bldg. ❑ Pubfic Sewer <br /> Accessory Building 1 ❑ Single Family with ❑ Deck <br /> ❑ Relocation ��,(^f r� detached garage ❑ Office/Commercial ❑ Pnvate Sewer <br /> ❑ Other. (specify) �I. i �(� ❑ Muitiple Family/Condo ❑Warehouse <br /> � � � � ❑ Pubfic ❑ Storage ❑ Public Water <br /> """Any earth movement may 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 �� t �6 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or , <br /> Estimated Construction Valuation (excluding land) $ <br /> J <br />