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. � ,��,,,,�- 7 -9 - t� <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION � �� <br /> FOR NEW STRUCTURES OR ADDITIONS /�� <br /> �O . `O Mailing Address: Permit number: � — <br /> IV PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: � <br /> `� �' Orono, MN 55356 <br /> `�'�ESH�¢� Total Fee: aD�� — ��`5 / <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: �� c� —f'�' �) ��'� �/��' <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 approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI NT INFORMATION: o <br /> Name: � ��C�� ��L �1 ' <br /> State License# " '�� Expiration Date: '� y � /� <br /> Phone: cell 2 Q office , <}-f�-� ,� <br /> Mailing Address: "� Cit : ZIP: �_ <br /> Contact Person: ,�/ ( S �" Applicant is: ntract ' / Homeowner �c��cie o�e> <br /> Email and/or Fax: � o �u � <br /> PROPERTY OWNER INFORMATION: <br /> ►vame: :��C S.�4r✓ � 7-D/� �--1 c���v�9�,C) <br /> Phone (day): <br /> Address: �— rZ /�I�d (;j/fi�/� City: ��.�v t► ZIP: ��3,�� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 �Qeck <br /> ❑ Relocation �► � _ ,J detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) �E,;�,���•— ❑ 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) �O�e�'�,Sp%�i�) <br /> 18202 Minnetonka Blvd F�(I ( <br /> Deephaven, MN 55391 � <br /> Phone: 952-471-0590 . � f�,�/�v <br /> Fax: 952-471-0682 � <br /> www.minnehahacreek.or �� <br /> Estimated Construction Valuation (excluding land) $ ��� �� v <br />