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� � �� ���� <br /> , �` <br /> >l 1 � �� <br /> CITY OF ORONO "`�9. dl� <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � �^, Mailing Address: Permit number: Z6 t- ' ���� <br /> � O <br /> �� � 'V PO Box 66 <br /> 1 r Crystal Bay, MN 55323-0066 Date received: rQ- - � <br /> l� :. � i <br /> StreetAddress:' Received by: <br /> � �/ 2750 Kelley Parkway Pian review fee: � <br /> � `' Orono, MN 55356 <br /> !kE S H� � Total Fee: a U f� � U D '!J 7 7 <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 /> Incompiete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: / <br /> Job Site Address: yyU �i�j -�s�qn�G <br /> Will this be a Parade of Homes, Remodelers Sh case Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wiU be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATI N: (� <br /> Name: S vtin BS"� i �1- S a !-loWt,� S <br /> State License# �L �O 3 616 7 Expiration Date: 20 /,� <br /> Phone: cell 2.. Z _ S' (o office �- � -,S,�j� <br /> Mailing Address: 0 2 Cit : ,� ZIP: ,SS3 <br /> Contact Person: o Applicant is: ontr ctor / Homeowner �c���ie o�� <br /> Emailand/orFax: ', ohnto✓la wa�,�scr�� ornes ��►'� <br /> PROPERTY OWNER I FORMATION: .n <br /> Name: �o��l A�' g�ic�e I����nNnr1 <br /> Phone (day): - 3(o ^ SO / <br /> Address: 2/�57 Mrn��fbn�cw �vd. (��:-� l2 City:�X��s�n(� ziP�5S331 <br /> Email andbr Fax 'i otin . �`e;�� I` c✓;hAs yp s, eorvi <br /> ARCHITECT/ENGINEER INFORM TION: ��/ <br /> N a me: �.lA.�cici �w►�C "' ) I r►� ���PT R T�I <br /> Phone (day): ,S-2 -. 2, <br /> Address: � S So . Cit :��c�;(� wrZIP: �yy7 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�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 ❑ Public Water <br /> *"Any earth movement may also require ❑ Commercial � Other(sp cify <br /> MCWD review&permits. ❑ Industrial ��as oh�� �R�;h �Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other: (SpeCify) <br /> 18202 Minnetonka Blvd � � � <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 S`Ltd�v�p.� G Cnb�✓1 <br /> Fax: 952-471-0682 ,,/� <br /> www.minnehahacreek.or /v O R/'R � <br /> Estimated Construction Valuation (excluding land) $ 2 �OSOUQ <br />