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. /�-� �°�`� <br /> .N� � <br /> �. p,�� <br /> CITY OF ORONO y�-1 � _� <br /> BUILDING PERMIT APPLICATION ��9 �-5 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> q, Mailing Address: Permit number: �l�/ �- D7J � <br /> ��'Y �-a*y�� PO Box 66 <br /> �j, Crystal Bay, MN 55323-0066 Date received: - <br /> � Received by: <br /> �, f <br /> Street Address:' <br /> \,\�,� �,1 2750 Kelley Parkway Plan review fee: o7vZd� �� <br /> � ! `�' ' Orono, MN 55356 a���, ��� <br /> �Q�fSHU@'� ,, <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 submitt gv�7 <br /> Incomplete applications will be returned. (Please print) U <br /> GENERAL INFORMATION: <br /> Job Site Address: I L` �! C'lt a��.' V �E"�µ�� � �)�- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �-�fQ'o- <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP ICANT INFORMATION: <br /> Name: ����� ��:5-��-� ��.�,5 �v� <br /> State License# ���3 ,k� Expiration Date: �f 3� l ti, <br /> Phone: (cell) 7�3-c���-- :S�/ � (office) "7�3� �TS 3 - �x��� <br /> Mailing Address: � �• ! � Li����,.J Cit : '� . ,,� ZIP: - -v!t <br /> Contact Person: r ��,� �.•� Applicant is: ontrac� / Homeowner (Circle One) <br /> Email and/or Fax: _�'��- 6,; �y S'� ( �c1 ��:-Cc,���� �i�0 3- ��3-3�'�3 �t <br /> PROPERTY OWNER INFORMATION: <br /> Name: r�we,,,c.( /3e Y�'/"L4rJ <br /> Phone (day): 7'b,3- �V- frS��S <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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& <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 j r,�_ ❑ Public Water <br /> "'Any earth movement may also require ❑ Commercial QOther(specify) �����y. <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 �. <br /> Fax: 952-471-0682 <br /> wtivw.minnehahacreek.or <br /> �� <br /> Estimated Construction Valuation (excluding land) $ -�Lr��C <br /> � <br />