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CITY OF ORONO <br /> . ' ' BUiLDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �A,.O Mai/iPOBox66. Permitnumber: Z�� � � <br /> i v <br /> Crystal Bay, MN 55323-0066 Date received: �7 <br /> � Street Address:' � <br /> y�. G�'� 2750 Kelley Parkway �� � lan review fee: . �D$ <br /> �a�sHo�`�' Orono,MN 55356 2 b� 't'� <br /> Main: 952-249-4600 Total Fee: <br /> 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 /> Incompfete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: ,/�_,, <br /> Job Site Address: � � S� , i''"/ �1 `Z. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> K yes,a special event perm/t is required wflh Po/ice Department and Clty Coundl approva/60 days prior to the event Shuttle bus�ivioe wil!be <br /> requlred unless applicant demonsbates suA"icient on-site parking Is availab/e. Non permitted events will not be allowed. <br /> CONTRACTOR/AP�ICANT INFORMATION: <br /> Name: T�JI �I�r.�r�ov�c� /—���.,.cb�� <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: Cit : ZIp• <br /> Contact Person: Applicant is: Contractor / Homeowner �c�.cb o�� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �iq.�� l�D cs.r„ea,,,,� <br /> Phone(day): ��Z- Z�'n 9 Y�� <br /> Address: ���_ys),•,2-1'L� �,,,,� !'�i2. CitY� O��NV ZIP• �S'„3�±-� <br /> Email and/or Fax �,or,�� v�,��5.r,2�. �.� �,,� <br /> ARCHITECT!ENGINEER INFORMATION: <br /> Name: �( �,�,�.�2� <br /> Phone(day): <br /> Address: City: ZIP• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: '�� c�-f-� �'�1�� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> �I�w Construction Water Supply <br /> ❑Single Family with �i4r.�essory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck lic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑Residence <br /> ❑ Other.(specify) ❑ Muwple Family/Condo ❑ Retaining Wall(s) � Private Sewer <br /> ❑ Pubiic 4feet or greater ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review&permits. ❑ Industriaf ❑Warehouse �rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑p�e�;�sp�y� ❑Q�B�(speCify) <br /> 15320 Minnetonka Bivd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minn hat�acreek.o <br /> Estimated Construction Valuation (exciuding land) $ _���-�� <br /> Last Updated: January 2015 <br />