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� � . <br /> , \ , � <br /> � � CITY OF ORONO ,��� gS �• � <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number. � � � "'�t�.�� Ci <br /> ���j PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' - 1Received by: ____.� 3 ,�d <br /> y � 2750 Kelley Parkway � �L v l�-�� p�an review fee: i ��7 � ��� <br /> �'� L Orono, MN 55356 � -—`_ � <br /> ,�KES�O��, _ _ __ __.__ _ � <br /> _.,____ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �. r ' ✓ <br /> This application form must be completed in full and all required information must be submittA . <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �/ � /�� <br /> Job Site Address: �`i ���� ���J������U�1�� � � "���d �� � <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitied events will not be allowed. <br /> CONTRACTOR/AP LI NT INF RMA;TION: <br /> Name: Gl 1� t � � <br /> State License# Od Expiration Date: 3! �-dJ <br /> Phone: (cell �p�a--,Z7� � (office) -�',S-O�.3 <br /> Mailing Address: d "" — Q, �/ Sca f0l Cit : �Y�Ae ZIP: S�3 .3' <br /> Contact Person: S� �q "" Applicant is: ntractor Homeowner (Circle One) <br /> Email and/or Fax: 1,�.) �c@ <br /> �t,t a,{-�J�Io�o+�6 <br /> PROPERTY OWNER.If�FChOFj,�AT�N:\ � Id <br /> Name: V�l :X��'4.a. � t�w� t P�L'S <br /> Phone (day): "-��� I ZIP: �J�3Y <br /> Address: 1 ^ tJl, ^ �G �2�V--e.. /� �D� Cit : �r1+1E'1t�c <br /> Email and/or Fax E/� e W�u ul � S . G <br /> ARCHITECT/ ENGINEE FOR JATION: <br /> Name: <br /> Phone (day): o� , � \ I� <br /> Address: — � �,eG. R.tl/:Q � � Cit : Y�+�h�* ZIP: ��� <br /> Email and/or Fax: y{^ ✓� d td �~ <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ew Construction 0 Single Family with Residence �'' <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. �ublic Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation /detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) [l 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) ❑ Other: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> P hone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wwv�.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � A ��� ��� <br />