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c�.(c � rssc�e p��G�-- <br /> � <br /> � � ' ��'l�-�^"� N t �'i N� � t N S <br /> CITY OF ORONO �c� �/ /�'v<c�/ t� � <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> A`,`� Mailing Address: Permit number: <br /> �O`VO�, PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' Received by: <br /> � � � 2750 Kelle Parkwa <br /> �, G� Y Y Plan review fee: <br /> Orono, MN 55356 <br /> `�KESH���� v`��/�KJ <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. (Please print) � 3 <br /> GENERAL INFORMATION: ��� <br /> Job Site Address: � (.c� � 7 C /1 s l c_• �C ��� T' �r (,�-�-�7;� ` ,,�. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �-Pde� <br /> /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wi/l 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: �V ��� 3L; ��_� r;�Z 5 IV�-� <br /> State License# '� C. ��, 3 7 7 L � Expiration Date: Zc;�b <br /> Phone: (cell) (c�l 2 - 3(.: 6 - �{1 1 G ��„va,�,f (office) �.0- 7 5 L• —y�� t C. t�.� . <br /> Mailing Address: 3 c ._ � Cit : �� � ZIP: ��'�� <br /> Contact Person: �, � ` �s " 2„ ,t Z Applicant is: ontr / Homeowner (Circle One) <br /> Email and/or Fax: L n,�,� _�F �' /�J�,G)3��►u7�e s vnv� . � L��-� <br /> PROPERTY OWNER INFORMATIONf <br /> Name: � ,�� t �,J�.��� Sr,:y cl r:L <br /> Phone (day): ,5�,-7 T�,> -- (pC}�Z, <br /> Address: ���c�'7� C/�'S l Ci ��i i�,� (Zc� . City: � �,,�z�r z,�- ZIP: ��.3 -�i"� <br /> Email and/orFax -J — r' —SNY��,� (=�i �Y�.�.� � � .z� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> �,rf�� �; ��� , � <br /> PROJECT INFORMATION: Description of pro�ect: ar2t SS �� ���``" ��d / ,��nl�7(i�-� ' ��$S ����`� �� , <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 �,�� �S <br /> Water Supply J <br /> ❑ New Construction ❑ Single Family with � Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. [�Public Sewer <br /> ❑Accessory Building [�5ingle Family with ❑ Deck <br /> ❑ Relocation � detached garage ❑ Office/Commercial [��vate Sewer <br /> 0'6ther. (specify) Iti���"��- �'�l►����'S ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> "'Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial �LP'rivate 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) $ � e � ��%�-' � <br />