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� � � �' � D <br /> CITY OF ORONO -06��`�� �� <br /> � <br /> 5 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O 1" Mailing Address: Q� — �� � <br /> �- � � PO Box 66 Permit number: <br /> / � ` Crystal Bay, MN 55323-0066 Date received: � �� <br /> �, � � StreetAddress:' Received by: <br /> �'e�yF '� ���� 2750 Kelley Parkway Plan review fee: � � <br /> � "% Orono, MN 55356 ab�y� ' <br /> ��`����_ ������� Total Fee: � �� <br /> Main: 952-249-4600 Fax: 952-249-4616 wv��w.c!.oronamr.us I � �. �� � , <br /> , <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete appiications will be returned. (Please print) <br /> GENERAL INFORMATION�/ � �` '��� ���� <br /> Job Site Address: �p <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> lf yes,a special event permit is required wrth Police Department and City Counci/approva/60 days prior to the event. Shuttle bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �� <br /> .., <br /> State License# �C�O t q'. Expiration Date: /�,.r^ <br /> Phone: (cell) (office) C�,""/-(r 4� OZ:�� � <br /> Mailing Address: �Q ,�1�,� ` °�! f�,L;j �l� /(� >; Cit : �` ;t ZIP: �"`�j <br /> Contact Person: p f/n/ ' � Applicant is: �n or Homeowner (Cirde One) <br /> Email and/or Fax: �,.� j- l.�!jr` - �r-? / <br /> � ,'J , (I � " <br /> � � <br /> PROPERTY OWNER INFORMATIOf�� <br /> Name: '�"ir1 :'K %�6L' �'��'f(f�lS� <br /> Phone (day): �t 2-30 -,�p,�j <br /> Address: �,,� �����/ 5i , c�ty: Q Q�-r/d zi P: 5��S�, <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> / i <br /> PROJECT INFORMATION: Description of project: �a �4G /7E ��f�'��f►� �/�hCfl�'/Cf � <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. ❑ 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 8�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) $ �� � 4� <br />