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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: 2 _�SO <br /> O` r PO Box 66 Permit number. _�7 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> 1 Received by: <br /> Street Address: <br /> ��l1 <br /> 2750 Kelley Par <br /> `ay f review fee:Z <br /> Ov <br /> kESHOCOrono, MN 5535 <br /> Main: S cpy <br /> 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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: 7(�,p AVC— <br /> Will <br /> 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 bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT <br /> _ IN�=en�4� <br /> IO <br /> Name: <br /> State <br /> License# Expiration Date: <br /> Phone: rcell ZZ I—­7,7 ,r office <br /> Mailing Address: fy�tCit :�1 ZIP:Contact Person: Applicant is: Contractor / omeowne (circle one) <br /> Email and/or Fax: /Sa.� /tel L. fr�a-. i 7�i `f7,5r b 2 .0 c <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): [ems•/ -Z2 f- ?'Z7(3 C �� ��, <br /> Address: Pr o. W>e 4 / u'+ <br /> City- %'f�;1 ZIP: <br /> Email and/or Fax 77k;_ Lf7 g-►-d_7o <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit • ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.S r ture Type 4.Sewage Dis�osal <br /> ❑ New Construction Water Supply W <br /> 'Single Family with ❑Accessory Bldg./Garage <br /> OkAddition attached garage ❑ Deck [Public Sewer <br /> tj-Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage .P-ftsidence <br /> ❑ Private Sewer <br /> [Other:(specify,4G ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater KPublic Water <br /> "Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> )—LAminnehahacreek.or <br /> a� <br /> Estimated Construction Valuation (excluding land) $ - r <br /> Last Updated: January 2016 <br />