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r � � <br /> . � 1'" � <br /> CITY OF ORONO / �c��• <br /> BUILDING PERMIT APPLICATION `."� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �o�o J Mailing Address: �01 �p _��a <br /> � PO Box 66 Permit number: <br /> ,� �� Crystal Bay, MN 55323-0066 Date received: <br /> � <br /> + c��-1`�' 'l� StreetAddress:' Received by: <br /> y� � �/ f.` 2750 Kelley Parkway Ci� Plan review fee: ,�O 3 • <br /> t �' � Orono, MN 55356 � <br /> qKFSH��� 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 applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 7(] � ✓��c-v �Cr.��cu/ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or othe isplay 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 wi be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFO ATION: <br /> Name: /�f Or'� d�1� �C <br /> State License# 8 C, (o, 9 a-1� Expiration Date: � /- / 7 <br /> Phone: (cell) Il- �(o- ?!P!o/ (office 7�i3•SS ��- 9/ <br /> Mailing Address: � N SiC, Q Cit : ZIP: SSY�l <br /> Contact Person: �h iS No�— Applicant is: tractor Homeowner (CircleOne) <br /> Email and/or Fax: Gt7n S rL rtor-�� �-trl)-nes c�v�--� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,�C, /1'1 <br /> Phone (day): (e 1 1-7 Sb '�D <br /> Address: 0 t2,�d /L� Cit : Cd�fCrJf'ao�n ZIP: S$3`(C� <br /> Email and/or Fax �(��, n by'�n{ntjmt S. �p-� <br /> ARCHITECT/ ENGINEER INFORMATION: • , _ <br /> Name: .�i,rY1 c,S ►'�c..lUe� �7L� ��/� a �3t9r� <br /> Phone (day): (.if1��q0 ' 03�Y4' ,I�, <br /> Address: f SQSO a.3r' f}✓t, City: P��f/)I�T✓T h ZIP: SSyY� <br /> Email and/or Fax: Jp�l'n�S/')1 t,n{ �C a , c ctv� <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction 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 [�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 �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) $ `���d��„�Q <br />