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f w` <br /> . � ' CITY OF ORONO � � ` S , <br /> BUILDING PERMIT APPLICATION <br /> I � 4 � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> ��n\ Mailing Address: Permit number: - <br /> % �`�O PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> ,� ' Street Address:' Received by: - Z / -� <br /> I1�'�` �:/ 2750 Kelley Parkway Plan review fee: �, <br /> '�h"esH��'� Orono,MN 55356 �[, <br /> � Main: 952-249-4600 Total FeeL �1 �_�, T S � <br /> Fax: 952-249-4616 ww,u.r,i.orono.mn.us � r.�� <br /> This application form must be completed in full and all required information must be submi <br /> incomplete appiications will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: _3�:�.� ���-���v S � <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home1 ❑Yes No <br /> If yes,a special event permit is requirad with Police Departmen[and City Council approval 60 days prio�to fhe event. Shuttle bus service wdl be <br /> required unless applicanl demonstrates sulficient on-site parking is available. Non-permilted events will not be allowed. <br /> CONTRACTORlAPPLICANTINFORM TION: <br /> Name: % Z �(�/1 .INc_ <br /> State License# �G L�j =j j/� Expiration Date: <br /> Fhone: (cell) �/� -��t—�`"7�i� (offiice) j�;3i - `�`73--y-��4 . . <br /> iJailing Address: � Cit : 'ZIP: � � <br /> Contact Person: - C�� Z, Applicant is: ontrac or ; / Homeowner �ciRi.o�.� <br /> Email and/or Fax: � ��, �� �� u,-U ��yy�_ <br /> .J <br /> PROPERTY OWNER INFORMATION: ^ <br /> Name: _�1�'�;p� ,C N f�.ri� <br /> Phone(day): <br /> Address: :-��,E,.��" �, ,�c�,, _�7— City C�r'I,pn! ZIP• ��� <br /> Email and/or Fax � �--c <br /> clY ' /j., t' �/ /' ,_��>� <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: � //� <br /> Name: �V <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 Accessory Bldg./Garage <br /> ddition attached garage Deck ❑Public Sewer <br /> Accessory Building ❑ Single Family with ❑Office/Commerciai <br /> Relocation detached garage ❑Residence <br /> ❑Other:(specify) ❑Multi le Famil /Condo ❑Private Sewer <br /> P y ❑Retaining Wall(s) <br /> ❑Public 4-feet or greater ❑Public Water <br /> "'My earth movement may also requlre ❑Commercial ❑Storage <br /> MCWD review&permits. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) �'Other:(speafy) ❑Other(specify) <br /> 15320 Minnetonka Bivd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 2 '� �'�t�.,�i`j� <br /> Fax: 952-477-0682 � <br /> ���,vw m[nnahah��rsek.or^ <br /> Estimated Construction Valuation(excluding land) � _�,��;a�-j� <br /> LeSf Uptlated:January 2016 <br />