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/ <br /> � ' , CITY OF ORONO � � -�p (� .7 S <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O MailingAddress: Permit number: o��/ -� ��S <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7 D/-/ <br /> StreetAddress:' Received by: �f T <br /> y�, � 2750 Kelley Parkway Plan review fee: °z- 'z--�lP•� <br /> � �' Orono, MN 55356 p�0/ - �b�8� <br /> `qkESHO � Total Fee: <br /> Main: 952-249-4600 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 appiications will be returned. (P/ease print) <br /> GENERAL INFORMATION: . <br /> Job Site Address: ��S l�� {✓��y r� (.« vt � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> !f yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. ShutNe bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �� �1 ?c>� ��U�'r�r <br /> State License# " .��'� Expiration Date: <br /> Phone: cell �� j --7 � - � �;�; `� office <br /> Mailing Address: (� J(;�� f)I So.� t'�'l�✓r� �.� Cit : �,c, ' ���, �,� 1�. P: <br /> Contact Person: j f� v� Applicant is: ontracto� Home wner (Circle One) <br /> Email and/or Fax: �-(-t�,n �, ��a,tiU.�4� �erv.rs. (��'f - ---- � <br /> PROPERTY OWNER INFORMATION: <br /> Name: ������Y'�i ����rc, <br /> Phone (day): � w <br /> Address: City: ZIP: <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: <br /> 1. Type of Project 2. Pro sed Use 3. Structure Type 4. Sewage Disposal 8� <br /> �^ Water Supply <br /> �-P4ew Construction i Single Family with [�]�esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial � rivate 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 rivate 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) $ �� C%�'c"C-L;` <br />