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� � <br /> 5 <br /> IR � � <br /> CITY OF ORONO �/� <br /> BUILDING PERMIT APPLICATION . �� , <br /> FOR NEW STRUCTURES OR ADDITIONS �,�� �7���� r <br /> O Mailing Address: Permit number: 01�0/ — dl/� <br /> � NO PO Box 66 U <br /> Crystal Bay, MN 55323-OOC�6 �' Date received: ! 'a�—/ <br /> Street Address:� � + 1�� Received by: /� <br /> ti � 2750 Kelle Parkwa � �l �� � <br /> � Y Y �'�'� Plan review fee: <br /> `�tq �,� Orono, MN 55356 � � /�, <br /> kE S H�� Total Fee: � ������5`� <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: ��-//O G�uYr l��,� O✓'o�.o /`/l� SS'39/ <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 ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMaTi��G <br /> Name: S�w�wa� <br /> State License# � 5�(H 31 S Expiration Date: 3 - �� - l� <br /> Phone: cell �2 -ZG'7 -Z��o office i2 -yIDZ-HDG� <br /> Mailing Address: 3 �..c f � rc�t Cit : Z..�- ZIP: SS 3 9/ <br /> Contact Person: �r.K Gr�•.r soH Applicant is: Contract r / Homeowner (CircleOne) <br /> Email and/or Fax: svr�. � �' w�woo , co�. I��5��(�d' S�Dvl�cti��� , C�i'�i <br /> t� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �C��� �� �urc�o- �m v��,.s�o.,. <br /> Phone (day): 17 Z -!0 3 9 -!oo S 3 <br /> Address: !N!b �vy � City: Oro�.o ZIP: SS' 39 � <br /> Email and/or Fax kw;� � '9� M�;1 < �� <br /> ARCHITECT/ENGINEE�INFORMATI N: <br /> Name: f}lGx�,,,.�.,,1�� as%x� �►'°"`� <br /> Phone (day): 9 2-H?3- S??7�— <br /> Address: o/ L.�- h-w-� Cit : � z�•-� ZIP: SS�9/ <br /> Email and/or Fax: f��►.f .�� �K�s.,,., w cs�w�roµn • �w <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �New Construction [v�Single Family with Q 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&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef: (speCify) <br /> �8202 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) $ �7S CCC� <br /> � <br />