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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: l <br /> � �O PO Box 66 � j`-,_ �_ • <br /> Crystal Bay, MN 55323 0066 Date received: / / <br /> Street Address:' Received by: �C/ <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `� �' Orono, MN 55356 <br /> t�'rES H��� �`/�'�-N�-'� � <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: �j1� � y�1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a specia/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/APPLICANT INFORMATION: <br /> Name: f� <br /> State License# �(��''3 83y Expiration Date: 3 �t <br /> Phone: (cell) -jlo3— 2�qto -Zs}ZR (office) �52- �210- b$� <br /> Mailing Address: Q � -T-. Cit : ZIP: Ss <br /> Contact Person: ��aS �R-��s Applicant is: ontractor I Homeowner (Circle One) <br /> Email and/or Fax: ��.��5 pu-t-poo�aEy�Gr.PiES L'��, <br /> PROPERTY OWNER INFORMATION: <br /> Name: }�-Tg �TARrI£�2 <br /> Phone (day): `1,I"1 - �b 4- �a�b <br /> Address: 'Zs��� F��L�!t�E�s.► 1-J�1 City: F,hZ,oN O ZI P: �`s'� q�_ <br /> Email and/or Fax ►�-t-ARr.1�. t�'lS�.l C�or+�. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /V�� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> — /�re�..,.� rc', �� (�� <br /> PROJECT INFORMATION: Description of pro�ect: -c�-�' L'x;�s 5�=� ��' • '����- N�� ��� GS <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & /te� <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) '�•��� ❑ 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 /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> r' cK�� <br /> Estimated Construction Valuation (excluding land) � ��, 7� <br />