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CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> f��C1 Mailing Address: D —D ,/ <br /> i ��� PO Box 66 Permit number. 5R- <br /> Crystal Bay, MN 55323-0066 Date received: /.� //—/ <br /> Street Address:' Received by: <br /> .� a. -- <br /> �yF �� 2750 Kelley Parkway _/ � lan review fee: ��/ �— / <br /> �,q �,�/ Orono, MN 55356 �`u ��Z� � / <br /> kcsrto�. �-L__s �7.� <br /> �.....�._ o a 9 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �) % , )-r', <br /> This application form must be completed in full and all required information must be submitted. <br /> lncompiete apptications wiil be returned. (P/ease print) <br /> GENERAL INFORMATION: - �� �� � r <br /> Job Site Address: � � � / � � /2 <br /> Will this be a Parade of Homes, Remodelers Showcas ome or o er D� lay Home? ❑ Yes No <br /> /f yes,a special event permit is required with Po/ice Department and City ouncil approval 60 day prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP CANT INFORMATI N/: • / <br /> Name: �� '� / , [ �,.�;.%�� <br /> State License# Expiration Date: �3 � - <br /> Phone: cell _ _ p ---' office � o p, ' � <br /> Mailing Address: ' � / Cit : � ZIP: <br /> Contact Person: � Applicant is: ontr�/ Homeowner (Circle One) <br /> Email and/or Fax: / - - � �.�,� <br /> PROPERTYOWNERI R ION: , /� ,� � 2��0 <br /> Name: �F-� � �� <br /> Phone (day): , , _ ��� �I <br /> Address: ��,J ��t�'��C/�, ,�� City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEE INFORMATION: <br /> Name: f-��y ,,� ,.,_ <br /> Phone (day): 1�._- _- �v 7 <br /> Address: Cit : � /� ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> ❑ New Construction �ingle Family with �-Residence <br /> �-Addition attached garage ❑Garage/Accessory Bldg. �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑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 /> www.minnehahacreek.or <br /> / <br /> Estimated Construction Valuation (excluding land) $ �Q' �2j v �� <br />