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� ' � CITY OF ORONO <br /> (P /$/, 7S <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: �� --Q Q <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 � n Date received: ���—' <br /> �F'(/ <br /> Street Address:' v�y� Received by: <br /> � 2750 Kelle Parkwa � � [� <br /> y�. � Y Y � Plan review fee: � �J / <br /> � Orono, MN 55356 �� 3_�'/ <br /> !q Kf S H��� 7�- <br /> Total Fee: a d � d <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compieted in fuil and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: J(�-�� .�((��� (�'� �`,` � �f�� �S��t <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes, a special 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: ,�;.,�rL;,;,, C� -r,: - .L�;c:s <br /> State License# C`_ - 39��,�,>;� Expiration Date: ,�j ,3 � �e,f� <br /> Phone: cell ^ - � office <br /> Mailing Address: - � r :y � Cit : - - ZIP: <br /> Contact Person: r�,;�� Applicant is: ontract I Homeowner (Circle One) <br /> Email and/or Fax: �?�:;�� ,,4+,�,��o.K,�c:.;;.,�.�; ���,�,�� _-C.�.-r-.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: l� �►'Z� � e,�aRc.:� �C.N th�.� <br /> Phone (day): � �J�2 - j� �- (��.,27 <br /> Address: ,y2 }� _G -�5�_,��..� lJ,��: �Q_._ City: �%lc.;�.z,vlj ZIP: �5��2,� <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATI N: <br /> Name: {'�P►1�`i i...�7tA �'�r� <br /> Phone(day): �- " �- .'7�� <br /> Address: yo i � 'LA� , �3 City: �(.i,.�y Z,n� ZIP: SS..�1'/ <br /> Email and/or Fax: c.�yw� , fJ.-�-�P;•��c;t.- �Cs.���::��-�' _G�y,.. <br /> � <br /> PROJECT INFORMATION: Description of pro�ect: r�� �.,�v�.� <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br />�ew 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&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 /> �^ � <br /> Estimated Construction Valuation (excluding land) $ J�,pC� <br />