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� <br /> � T CITY OF ORONO <br /> BUILDING PERMIT APPLICATION �' �5 <br /> FOR NEW STRUCTURES OR ADDITIONS 1��g� <br /> ��0�� Mailing Address: Permit number: 2 d/5� � �2 <br /> ' O PO Box 66 _ <br /> ('� � Crystal Bay, MN 55323-0066 � Date received: � Z,�j' �S <br /> S tree t A d dress:' Received b y: Z.{� <br /> yF �j7 2750 Keliey Parkway �I l (/ Plan reviewfee: �lC�� -1 ca.��y;p:f • y�.k_ <br /> tqK� ���.`' Orono, MN 55356 I � <br /> S" � �,3, 8 <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 will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2�"'10 Cati3g�Es�rouE �c�CL'T' <br /> �II this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: GjA1Al4�ou1S E <br /> State License# 'aC.ov 2.3$Z Expiration Date: '�-3 t - Zt��C.� <br /> Phone: cell office �,03• 5 3- O 5 Z <br /> Mailing Address: '�4D yr�, RQ� N. Cit : �vc30,. ZIP: Zz <br /> Contact Person: �A�.! 1�,t.t�l�K� Applicant is: Contract / Homeowner (Circle One) <br /> Email and/or Fax: -pAt�M,c.1yo5��( � ShVlcko�S�VSA_ /�t'� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Ciry: ZI P: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <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 8� <br /> Water Supply <br /> ❑ New Construction �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)�i-�_ i7SM.�. ❑ 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) ❑Othe�: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wvn�v.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � '21 DOC� <br />