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,. CITY OF ORONO <br /> ' BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ���T Mailing Address: �(���-b/� <br /> 1 VO PO Box 66 P��number: <br /> Crystal Bay,MN 55323-0066 Date received: 9- /s'_/ <br /> StreetAddr�ss:' ry�bY� /��� p <br /> 'y�, G� 2750 Kelley Parkway p�-� plan reviewfee: � ,�'j� <br /> Orono, MN 55356 i �C� J <br /> j'kESHo��' ���J" ����7� <br /> Ota ee: <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) <br /> GENERAL INFORMATION: <br /> Job Site Address: '�j�q� (� �,�y � <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 requi�d with Police Department and City Council appioval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufBcient on-site parking is available. Non permitfied events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORM�4TION: � <br /> Name: '�-OF�T G l� I �� c� i3 <br /> State License# '�,vpn ��:�� Expiration Date: 3y ZQ j <br /> Phone: (cell) Ca1 Z ' �{q'�� i'ZZla (office) 5�r►n� <br /> Mailing Address: q�µ Z�' �r i�1 D► Ci � '���0� ZIP� 5535� <br /> Contact Person: _�Dg Apphcant is: n r / Homeowner (Clrcle One) <br /> Email and/or Fax: Q,,b���, t,, �> ��� • C�,.,.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��-H13t�A/�I�1Z1���•T7 �n�Vvr�c.. <br /> Phone(day): <br /> Address: City• Z�P. <br /> Email and/or Fax ' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��-hh-�R.P� i�sy�,a.� <br /> Phone (daY): q��.� �.}1 v , c�� S t� <br /> Address: 4(04 Zr'� �°T #�� City•�.t-�c,l1o � ZIP� Ss��l <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> �New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage �Garage/Accessory Bldg. �Public Sewer <br /> Q Accessory Building ❑ Single Family with Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑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) [7�}.Other: (Speafy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 �'�V�� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or ��� �," <br /> Estimated Construction Valuation (excluding land) � j��; ��'� <br />