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, CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: Permit number: � --- �dI 7 <br /> ��lrj PO Box 66 <br /> �' Crystal Bay, MN 55323-0066 �� Date received: — � —/ 7 <br /> StreetAddress:' � � Received by: �� v �)F <br /> y ` 2750 Kelley Parkwa �� Plan:review fee: ` I <br /> `� � Orono, MN 55356 ' <br /> �`��Fswo�`� Total F : " <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 musf be submitted� �� C��O �g � <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� ''� [R�L,,;�Q e.�, w vFTe,.�. 12.i� t� �L � <br /> Will this be a Parade of Homes, Remodele s Showcase Home or other Display Home? [II�Yes ❑ No <br /> /f yes,a specia!event permit is required with Po/ice Depa�tment and Eity Counci/approval 60 days prior to the event. Shutt/e bus service wil/be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAN ORM TION: <br /> Name: W �1► v � L w'C- <br /> . <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 <br /> PROPERTY OWNER INFORMA ION: . <br /> Name: � �• � � � <br /> Phone(day): s ` ' � <br /> Address: �. Cit : t •wRMZIP: 3y <br /> Emaii and/or Fax '_' � � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): � • V� Xi�• <br /> Address: C i1� Cit : i M. ��" ZIP: Ss 3�3 <br /> Email and/or Fax: V i Ce 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 [�S�ngle Family with �esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bidg. [�rPeblic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commerciai ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �'�ublic Water <br /> �'Any earih movemen4 may aiso requir� ❑ 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 /> Estimated Construction Valuation (excluding land) � � S� 0 � Q • <br /> REC�d��'�,�.:� <br /> FE� t� � 101i <br /> CITY OF ORONO <br />