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. • <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �OA, Mailing Address: O � ��� b <br /> l VO PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: <br /> � ,� Streef Address:' —� Received by: ---_� d <br /> �'Fl G� 2750 Kelley Parkway ��1�-�� Plan review fee: � g'�+] < 3 ' r �' <br /> �k�,SHo��. Orono, MN 55356 3�� <br /> '''�–_ — <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 submitted. <br /> Incomplete applications witl be returned. (P/ease print) <br /> GENERAL INFORMATION: /1 �� /1� <br /> Job Site Address: 2�5� t,U f3t��ES"��� LQ� , ��.C'11'`� <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-permitted events will not be allowed. <br /> CONTRACTOR/AP LI NT INF RMA,TION: <br /> Name: )� � � <br /> State License# Qd Expiration Date: 3 t �� <br /> Phone: cell (p�o1—Z7D � office) -�/ -p�3 <br /> Mailing Address: � "' 5,,� (a� City: y��e ZIP: S�3 .3 <br /> Contact Person: rq — I pplicant is: ntractor Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER I FO ATp N: • I <br /> Name: ���I C,. �jwt tvte� <br /> Phone (day): t— � <br /> Address: 1 ' �,ti„ � •G i2��/_(„ �� 0� Cit : �✓1 ZIP: �J33� <br /> Email and/or Fax EA e („�c�v q { , � <br /> ARCHITECT/ENGINEE FORMATION: <br /> Name: <br /> Phone (day): � _ � <br /> Address: — ^ ',p„�, �V;Q � (J Cit : Yn�jtr� ZIP: ��� <br /> Email and/or Fax: yh �/� d ld . ti'N�. <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 � Single Family with [ 2esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation etached ara e <br /> ❑Other: (specify) [�Multi le Famil 9Condo � Office/Commercial ❑ Private Sewer <br /> P y ❑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 /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> w�wv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 3�S^dd Q <br /> I <br />