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� <br /> � �"V�lT"V� � /Y �� CJ I i "V � ��% ��� �✓ �lY� �L/� <br /> v CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O Mailing Address: Permit number: 2(���' �10� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: G��•� <br /> Street Address:' Received b : <br /> y �` 2750 Kelley Parkwa ��(��b � Plan review fee: �� -�� �" <br /> F �' Orono, MN 55356 <br /> t�kESHO�� 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: �-��� �,/, {j�,�;���_ , ;n ,�__ �_{�,u''L� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display 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 6us servi "will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: (.�.��,V e:,i� <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: _ <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATI ' <br /> Name: -� �����1)vYK� /�lY���,'�L�� — <br /> Phone (day): � � � � <br /> Address: �. — ,J,2-� Cit : � ZIP: �`�'`,'/ _ <br /> Email and/or Fax �- ��y,,,n-�-,nf�,t1�,�. C� L !3 �cJ<,�)JErt . U�—. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: r'���C��._>� <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <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 O r(s ecify) <br /> MCWD review 8�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 /> :aca <br /> Estimated Construction Valuation (excluding land) $ i �L�� w- <br /> � '� . <br /> � , . <br />