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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O • O Mailing Address: Permit number:p�� -. <br /> 1�T PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �a_c��j — <br /> Street Address:' Received by: L�(/- <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `� L Orono, MN 55356 <br /> ��'CE S H O�� ��J �/�.�� <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) �� � -�'f� <br /> GENERAL INFORMATION: n ,� , <br /> Job Site Address: 3� l.vLS'�tG�11 .��t' . <br /> Will this be a Parade of Homes, Remodelers Showcase 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. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be alfowed. <br /> CONTRACTOR/APPLIC�NT I FORMATION: <br /> Name: N/D O�'b'�bN C.. �11tio I��fi�bN L(�C.. <br /> State License# �G. (� 3�'q &S� Expiration Date: ?o�� <br /> Phone: cell f Z. 't`o Sr4 0 office <br /> Mailing Address: '� S /H•n ' G Cit :S{�l.oKcS � /'IL Z�P� �'��(o <br /> Contact Person: Applicant is: Q.�� / Homeowner (Circle One) <br /> Email and/or Fax: .k;�n Q W�o �lrH�t.•I�,Cy►n V���N •�✓ti <br /> PROPERTY OWNER INFORMATION: <br /> Name: (�Cv+�U �ull JVa1�n -- <br /> Phone (day): (,�'L. Sd 1 n S'3 <br /> Address: 1.f CnGsfi/itW 1/'C�. Cit : L��o ZIP: <br /> Email and/or Fax •Itdw✓�y�� �,A�q;� • PA�n <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �,/4 <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: �orw �'t- D�Se. 4���Ccid �t/�'CG� <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) �10�SG a,��Y�l�� ❑ Multiple Family/Condo ❑Warehouse <br /> ,�jptap�h �,N,�,�� ❑ Public ❑ Storage ❑ Public Water <br /> **Any eartMmovement m 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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ���� �� <br />