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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: —1�/ � <br /> g-D�TO PO Box 66 � - <br /> Crystal Bay, MN 55323-0066 �� Date received: o —�S'—/7 <br /> i � � ,p <br /> Street Address:' Received by: /�.� V /�� <br /> �' � 2750 Kelie Parkwa — � <br /> ti�; G� Y Y � Plan review fee: _ <br /> Orono, MN 55356 � <br /> �'��FSH°�`� T tal Fee: � I <br /> Main: 952-249-4600 - Fax: 952-249-4616 www.ci.orono.mn.us -�(�1 � � � . �'� <br /> This application form must be completed in full and all required information must besubmitted: <br /> Incompiete applications will be returned: (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � L' �i.i �, t9,� �4TGVe. (D 1R. � 1�C'.. . � <br /> WII this be a Parade of Homes, Remodelers Sh wcase Home or other Display Home? [I/�Yes ❑ No <br /> lf yes,a special event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAN I O ATION: � <br /> Name: L �`C-• <br /> State License# Expiration Date: <br /> Phone: cell � 0• office • • <br /> Mailing Address: C 1 Cit . IP: <br /> Contact Person: w 1. 1ti S Applicant is: ontracto Homeowner (Circle One) <br /> Email and/or Fax: �L C <br /> PROPERTY OWNER INFORMA ION: � <br /> Name: i �.. t► � • <br /> Phone(day): s ` ` O <br /> Address: Q. Cit : t •wRMZIP: 3y <br /> Email and/or Fax 'S' � � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): � • V� �• <br /> Address: C i V Cit : i M• ��''� ZIP: S S 3 Y 3 <br /> Email and/or Fax: V CO w►+. . <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> New Construction �ngle Family with �esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. QPRblic Sewer <br /> ❑Accessory Building ❑ Single Family wit h ❑ Dec k <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �ublic Water <br /> °tAny ear'ri� movemer�4�iay also �equ9r� ❑ Cammercial ❑ Cther(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 /> Estimated Construction Valuation (excluding land) $ � S� � � � • <br /> �>V�� <br /> F`�B 0 8 2017 <br /> CITY OF ORONO <br />