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� CITY OF ORONO � <br /> . g-� <br /> � <br /> BUILDING PERMIT APPLICATION �I <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailrng Address: Permit number: �� '-�/� <br /> PO Box 66 <br /> 0 Crystal Bay, MN 55323-0066 Date received: , 'l — <br /> � � Street Address:' '� Received by: ��, 3 Cl <br /> y � 2750 Kelley Parkway G�� Plan review fee: ���-U/D 7�`� <br /> `�� �,� Orono, MN 55356 (��� <br /> �kESH�� 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 wiil be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��,�q $ �� �o C��G�Z <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 pnor to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is avaifable. Non-permitted events will not be allowed. <br /> CONTRACTOR!APPLICANT INFORMATION: <br /> Name: Fat� .1- So �a �e.w�odz�i•�5 --- <br /> State License# �C b3�q 0'1 Expiration Date: D 3 �3 I l�o i b <br /> Phone: (cell) 1�(2- 5y�- g 33� (office) (o I 2 -2�(S-S$2 6 <br /> Mailing Address: 2 o E Av Cit : Ch1 l�n Z�P� 531b <br /> Contact Person: � JQ c arlSa� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: _T� �'a:r� ah� S�u�r rewodel � cow� _ <br /> PROPERTY OWNER INFORMATION: <br /> Name: Kcn-� av� d Su2.y Sw�arscsr; <br /> Phone (day): ZIP: ss39 I , <br /> Address: 32Zq T3 Casco Ci�cl� City: D�ono <br /> Email and/or Fax S�a,�5�7 � a o I Co n.� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: htar k NQ.sse-I- <br /> Phone (day): <br /> Address (032� EI►ti. 't're,� A�v CitY: �xc.t,�s�or ZIP: 55331 <br /> Email and/or Fax: �ar k l� N�53c� ,'�rrL.; �e�,-e �o►� <br /> PROJECT INFORMATION: Description of project: vn � ��f' �� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with �('Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �] Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation �'�" - t� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [�Other: (specify) 1�0��i't�. ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage l$Public Water <br /> **Any earth movement may also require ❑ Commerciai ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (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) $ (o�{ 040 <br />