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/ � <br /> CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� Mailing Address: Permit number: p?�/�t'�d�� <br /> PO Box 66 '/ <br /> � Crystal Bay, MN 55323-0066 Date received: �'a�3"� <br /> Streef Address:� Received by: <br /> y � 2750 Kelley Parkway Plan review fee: <br /> `� � Orono, MN 55356 <br /> `�KESH��� Total Fee: �p��,�� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and ali required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: _ <br /> , --, <br /> Job Site Address: � � 7�` �!<j.^� �•' �.�, ��� ����'�� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 7�No <br /> If yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle 6us service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: �, • <br /> Name: ��`►'��r�� L �",) i: U v���� <br /> State License# Expiration Date: <br /> Phone: cell �i 5 2 � � 6 `i E office <br /> Mailing Address: zt 5� rrr c� yt ci Cit : (%���� c ZIP: 5� 3 �'� 1 <br /> Contact Person: h���.-k- E , � 1 ,u Appiicant is: Contractor / �fiomeowner:;.��c���ie o�e� <br /> Email and/or Fax: ; M�r p t( � �ru� �� �` ��� <br /> � <br /> PROPERTY OWNER INFORMATION: �;�I � �—� �l� .'Ac <br /> Name: � r ` � I <br /> Phone (day): �; 5 � �� � 5 2 3 �' S� <br /> Address: z2 S� f�,c.�c , 1s;6,� I1 C� Cit : C��f �✓�O ZIP: c� � 3 9 I <br /> Email and/or Fax ►` wr �c-_�� �a �� ��� ' � ° � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ��, ��,. , .� �,�n' �l���^�S - r�� �(,�rrtc �/►'� O�aJ'+c,�tin�y <br /> Phone (day): 3 v� � 6 3 `�Y 3 5 �� �� <br /> Address: �r' � 7 ,`) .�- c f� �c� R o t`� � Cit : S�. 7�t.: � ZIP: <br /> Email and/or Fax: ���r '�, � ��,�n rl C �i��� (i% c,+����1 <a�� <br /> PROJECT INFORMATION: Description of project: <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) � Ot�er. (SpeCify� , <br /> 18202 Minnetonka Blvd 5' F�'��.�� �; �+(� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> $ DG <br /> Estimated Construction Valuation (excluding land) �� ��� • "'� <br />