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f f <br /> . • + � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: ,6 <br /> �� ��^IO� PO Box 66 Permit number: U / � fl <br /> Crystal Bay, MN 55323-0066 Date received: -2�- <br /> �y ��1- � �� Street Address:� Received by: <br /> �, ,. �, �� 2750 Kelley Parkway Plan review fee: c�(oc�,`fS <br /> `� � �'i Orono, MN 55356 <br /> �`�AfsH��``�� o�O�`�-DO �J'3�' <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 nn-+nn�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: �y 6� �c 2c S"%� ��`� �-�Jrv?7�N'G <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�� <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 su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: , <br /> Name: LE,� s ���,_?S.c-4,�-;.ti c=,r�" �5 ic�s.� -Z._-� <br /> State License# i3C �� >;-7�� Expiration Date: .� i �s <br /> Phone: cell �' - �'' g-- /.�/� office 7�.3 -�s�-»>,7 <br /> Mailing Address: ?, o �`' .�1 ' � ' Cit : / ,,�f r,e,.� ZIP: Ss 3�� <br /> .--. ._ � <br /> Contact Person: �,�,- "/ ,s� .-•-.,�� %-z Applicant is: �ntractoe---T` Homeowner (Circle One) <br /> Email and/or Fax: `U,�..�.,, c� L,�:�" s �.c���.-,r ..�s �.,��� C�,�:�? co.-�-. <br /> PROPERTY OWNER INF4.RMATION: <br /> Name: ��-�-� /.5��i�Tr-� <br /> Phone(day): ��.:s�--G ���''- �.�� :> <br /> Address: ;�yl`c> �� 2�"c-� G�-1�.E L:�.,,.-�,,,�s City: �, <<,:,,�� ZIP: .�.S����E- <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: I`i��'�C�' �� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> �lew Construction ❑Single Family with ❑ Residence <br /> ❑Addition � attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0'beck <br /> ❑ Relocation � � � detached garage ❑ O�ce/Commercial ❑ Private Sewer <br /> [�-0ther.(specify) //�� K ❑ 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 mmnehahacreek.or <br /> GiC�C� GC� <br /> Estimated Construction Valuation (excluding land) $ �S� ' " <br />