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� � / <br /> CITY OF ORONO I l���'7� <br /> BUILDING PERMIT APPLICATION � <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O • MailingAddress: Permitnumber: p�� ��� <br /> 1�TO PO Box 66 <br /> Crystal Bay, MN 55323-006� Date received: �� '7-� <br /> Streef Address:' � ' �1� I Received by: <br /> y � 2750 Keliey Parkway ti Plan review fee: g6• �'7 <br /> �r�KESH���G � Orono, MN 55356 ��I �0/i+/_D/�s� <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 /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��C'C� �'�'��� �j�-�� ���� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specral event permit is required with Polrce Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC T INFORMATION: <br /> Name: `� ' � <br /> State License# �j� Gc>f[�z.� T Expiration Date: 3 ( Z� 6 <br /> Phone: cell G l2, office '�Z� 2�'= ���� <br /> Mailing Address: ?�� � ��l � \ �J7 � �% Cit :.�L. ZIP: � <br /> Contact Person: � ' C%!'� Applicant is: ontrac o / Homeowner (Circle One) :� <br /> Email and/or Fax: �,v ��;ri.�.� - { <br /> PROPERTY OWNER INFQ.ki�ATION: � � ` <br /> Name: ' ���� 1-.�%l`�� <br /> Phone (day): c� Z-,�C�,�'�%3��a <br /> Address: ,,32-c%c% `�(�,=���ti�- City: ��-��� ZIP: <br /> Email and/or Fax <br /> ARCHITECT ENGINEER ORMATIOIy� �`��`''Z ��� <br /> Name: ,/N�,�� � <br /> Phone (day): ��(2,�'Z,7��Z-.S <br /> Address: �-a / 1�,� 2�� ���iC City:�'�-�� � ZIP:-�f�� <br /> Email andbr Fax: _��z,--���7�� �: � <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal S <br /> �� Water Supply <br /> ❑ w Construction Single Family with [�7 Residence <br /> Addition attached garage ❑ Garage/Accessory Bldg. �ublic 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�arth movement may also require ❑ Commercial ❑ Other(specify) <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 /> Estimated Construction Valuation (excluding land) $ ���i� ��� <br />