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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: Permit number: �- <br /> PO Box 66 _ <br /> Crystal Bay, MN 553 6 �\ l Date received: <br /> Street Address Received by: 7 <br /> y� 2750 Kelley Parkway �1` Plan review fee: <br /> !1 ��L Orono, MN 55356 <br /> Total Fee: <br /> KESHO 115.,!:�5 <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. �73� 7 <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <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 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 INFORMATION: <br /> Name: D R-5 kovv,E C-- pelrsuee: -(i <br /> State License# / Expiration Date: <br /> Phone: (cell) el,,�- ��, � X35 (office) Gam/2 - C�S 22'2`67' <br /> Mailing Address: 6, X199 ,6j.-,c e4 City: jyl&r.'kT ZIP: <br /> Contact Person: vsc% -e_X�- ���,/� Applicant is: on rac .. / Homeowner (Circle One) <br /> Email and/or Fax: ll �� !1 �^✓,gyp G��C i' (r►c c CG�� <br /> v <br /> PROPERTY OWNER INFORMATION: <br /> Name: a(Cc h ZZ_7< - <br /> Phone (day): _jS-,�A - 97.3- S l q/ <br /> Address: .315- "f e5el ��5�;� /fix— / City: e> 6,1c, ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: .�' .s•3 tis �, /�4-,�—&- <br /> Phone (day): <br /> Address: City: ZIP: <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 �Jlee'� detached garage ❑ Office/Commercial ® Private Sewer <br /> )f <br /> ® Other: (specify ❑ Multiple Family/Condo ❑Warehouse <br /> 1ile ❑ 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) 9.1 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 /> c5c� <br /> $ <br /> Estimated Construction Valuation (excluding land) <br />