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CITY OF ORONO <br /> - BUILDING PERMIT APPLICATION <br /> � FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mai/ing Address: Permit number: "�/� -- <br /> `VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: -- '�—/ <br /> � ,. Street Address:� r Received by: �1, 2%' <br /> �'F G� 2750 Keiley Parkway ��/ ��` � I n re�iew fee: � � <br /> ���• <br /> �.�K�SHo��. Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: <br /> 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 appllcatlons will be returned. (Please print) <br /> GENERAL INFORMATION: � f <br /> Job Site Address: L 3Q O h . �,�. VQ. �—�'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes o <br /> If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil!be <br /> required unfess applicant demonstrates sufficient on-site parking is available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/AP LICANT INFORMATION: <br /> Name: � �r�� , r. �� � c . <br /> State License# �3q 6���- Expiration Date: '� � j <br /> Phone: cell � office <br /> Mailing Address: ��l Cit : r,^ �, ZIP: <br /> Contact Person: r �,� ^ c,, � ;,� Applicant is: �n rac / Homeowner (Circle One) <br /> Email and/or Fax: , c ,�, <br /> PROPERTY OWNER�FORMATION: <br /> Name: ,�darr� � Z.P.c��, V,�x��'��'v_r <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Citv: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: ��.r.e ��c•S�:�. �c.� Q,. ��a� �.rl��.S� <br /> � <br /> 1.Type of ProJect 2. Proposed Use 3.Structure Ty 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ,J�Single Family with ❑Accessory Bldg.!Garage <br /> ❑Addition attached garage �Deck 19 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> �Other: (specify) ��.� ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑Public 4-feet or greater � Public Water <br /> **Any earth movement may also require ❑Commercial ❑ Storage <br /> MCWD review&permlts. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (Speafy) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minn hahacreek.or <br /> Estimated Construction Valuation (excluding land) � �, a� <br />