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, � <br /> CITY OF ORONO <br /> BUILDING PERMIT APRLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> _ ^�O Mailing Address: Permit number. � � �j—(��� <br /> �u�� PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: <br /> StreetAddr�ss:' iv • <br /> � Gti� 2750 Kelley Parkway 5���' Plan reviewfee: � <br /> `�t Orono, MN 55356 � � 'y � <br /> �x�sxo�`` 2 a � <br /> 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 /> �-yi�' Incomplete applications will be returned. (Please print) <br /> GENERAL INFORM 10 : <br /> Job Site Address:� o/� ti'�r�;/� LDf 2:2. 13/o�.k 3 Lc�-�i'z,cJ��e.� <br /> Will this be a Parade o omes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> lf yes,a special event permit is required with Police Department and City Council app�oval 60 days pnor to the event Sh le us seivice will be <br /> required unless applkant demonstretes s�cient on-site parking is availa6le. Non permitted events will not be ellowed. <br /> CONTRACTOR/APPLI ANT INF MATION: <br /> Name: �r,� �/'G <br /> State License# G 3 Expiration Date: 3- 3 i- /? <br /> Phone: (cell) 6 i�. 31��- 7G�/ (o��) 7C 3 5 f�1'z�9/ <br /> Mailing Address: / i� �S` de Ci : / �,d�-y�� ZIP: S`'i'yC <br /> Contact Person: C/�y�i5 /t/o�'�ok Applicant is: Contractor / omeowne (ClrcleOne) <br /> Email and/or Fax: CI�r.S►tl ca nvr�aK ,�Ja�o�. Go r� <br /> PROPERTY OWNER,,�I�FORMA�'ION): <br /> Name: C;/•r� s I'!/�i'-t�a/� <br /> Phone(day): 6��. 3t7G-7�� / <br /> Address: Ci : ZIP; <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: f�F�� � l�n►•��.�-y C� P.�s.s•1 � c�� . <br /> Phone(day): ~!6 3 -'?p Qo p ° <br /> Address: /mo c3.a,/-f,`�„�ar� ,.� �t/F City: �j (k.�'k ZIP: �S y � <br /> Email and/or Fax. <br /> PROJECT INFORMATION: Descri tion of ro'ect: �c.w e <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �1�lew Construction Single Family with [�j Residence <br /> �(]Addition attached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑Office/Commercial �rivate Sev�r <br /> ❑Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑Public Water <br /> **Any earth movement may also require ❑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 /> vwvw.minnehaha k. r <br /> Estimated Construction Valuation (excluding land) $ �3[7 2p n <br /> r <br />