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CITY OF ORONO � ' <br /> BUILDING PERMIT APPLICATION Qd�' (��� <br /> � �� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: ���� ^ ���� <br /> PO Box 66 ,/ <br /> � � Crystal Bay, MN 55323-0066 Date received: //'d7�3 <br /> Street Address:� Received by: �T <br /> y � 2750 Kelley Parkway Plan review fee: <br /> F �' Orono, MN 55356 <br /> `�'�E S H��� <br /> Total Fee: , <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � "'' N , �' �� <br /> This application form must be completed in full and all required informatio must be submitte . <br /> Incomplete applications will be returned. (Please prrnt) <br /> GENERAL INFORMATION: l / <br /> Job Site Address: � d- �� ��SG� (�I r�i �� <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 wil be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: I / <br /> Name: .S'�"(7�cr �n/AJ� G-.. �• l� • • <br /> State License# a,O S S' Expiration Date: 3 3/�/�f � ? <br /> Phone: (cell) S� OS. 9056 (office) 9Sa.,. G97_ SS90 <br /> Mailing Address: ? p � Z„r,.. a-,z.� Cit : y�,/��� ).� ZIP: SS� <br /> Contact Person: ��„y'I Ea._U�' Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: da vr� S�ar�-1✓o0�.Co✓� x <br /> PROPERTY OWNER INFORMATION: , <br /> Name: JG•�"�C S � �(71,1 r� <br /> Phone (day): 76 3. �l�.. O �7 0 <br /> Address: I1� �/04� bonl Gc�u,r�' City: Plyrpp�� ZIP: SjrGfl�/�� <br /> Email and/or Fax �Jp�(� ORo��r k�� A1�9S w�L P�c�. Gv►^� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��i�,ti`� �e,S,'� / <br /> Phone (day): $'�. -�� S6"7�7 <br /> Address: r.fd� � �..lE� S%rY,�v}- City: `„L�r�� �U ZIP: S 5 �9 � <br /> Email and/or Fax: (Ga fLrv , � le�C«�t��'dss,���a�r7,,�1� Go✓`� <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) ❑ 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) �,Other: (SpeCify) <br /> 18202 Minnetonka Blvd �e4��.�VsG.. <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ W�'3 �'vr'U''7t''b in1 �.�2``' h'"r� �„�-•K'`�-- <br /> V�A�-� -Nv �'-ee 5 t�✓-e.� l/J, _ <br /> �(,,�'.,.. <br /> /i-5 zdlj <br />