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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, Mailing Address: Permit number: ��— 0`� <br /> �v� Po BoX ss <br /> Crystal Bay, MN 55323-0066 Date received: � — <br /> �� R c ' : <br /> ,� Street Address:� �-� ��,r, , <br /> y�. G�'� 2750 Kelley Parkway ��w'� ,Y. Plan review fee: �Q. - <br /> ��kESH04� Orono, MN 55356 - —�/�Q <br /> Main: 952-249-4600 Total Fee: :,s • � <br /> Fax: 952-249-4616 www.ci.orono.mn.us �/� , (o � <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please prinf) �_;�Y,s�� ,C!zz��S <br /> GENERAL INFORMATION: �� <br /> Job Site Address: � �� � U C <br /> Will this be a Parade of Homes, Remode ers S owcase ome or oth r Display Home? ❑ Yes �o <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service � be <br /> required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP I ANT�IAIFORM T N: <br /> Name: �,r �- ��i �C. �- '��� <br /> State License# Y7 Expiration Date: <br /> Phone: cell - � , - � S'- - office ,.�,� <br /> Mailing Address: �� c Cit : �� . <br /> � ZIP: �-•- <br /> Contact Person: ,- -��, Applicant is: Contractor f Homeowner (Circle One) <br /> Email and/or Fax: _��l�t���q� �T� � �, ,-. �2�_11 h c�.._._ , c' r .� <br /> PROPERTY OWNER INFORMATION: <br /> Name: _'�c� �vT,,.e <br /> Phone (day): � <br /> Address: p��,r �.y�e� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: • �� <br /> Name: p4•�� b�+�. �� V� <br /> Phone (day): �O ������ <br /> Address: <br /> Email and/or Fax: � � <br /> • <br /> PROJECT INFORMATION: Description of p <br /> 1.Type of Project 2. Prop �� ������ � � �osal 8 <br /> ly <br /> ❑ New Construction ❑ Sing S f f� <br /> ❑Addition atta � r..�.� <br /> ❑ AccessoryBuilding ❑ Sinc ����• <br /> ❑ Relocation det� !r <br /> �Other.(specify) � ' ❑ Multi � �` <br /> *''Anyearth mo��t n�a a so equire ❑ Coml � O�ip //O ' <br /> MCWD review&permi�s. ❑ Indu: � <br /> Minnehaha Creek Watershed District(MCWD) O e <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> � O <br /> Estimated Construction Valuation (excluding land) $ l �✓' . � <br /> Last Updated: January 2015 <br />