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. . . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MaiJing Address: Permit number: v2��� L�� <br /> .�,0�. PO Box 66 <br /> O O Crystal Bay,MN 55323-0066 Date received: � / �- <br /> �, StreetAddress:' Received by: �� L� <br /> � G�' 2750 Kelley Parkway Plan review fee: � � �r -���00� � <br /> ��og,� Orono,MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This applicati�on 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: '���j 0 ��OSpeG�- <br /> Will this be a Parade of Momes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> !f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wifl be <br /> raquired unless appficant demonsfrates s�cient on-site parking is available. Non-pennitted events will not be allowed. <br /> CONTRACTOR I APPLIC {�fT INFORMATION: <br /> Name: � ( �Q o�i j Ji�G��^ �oM Qn <br /> State License# � �Oo( Expiration Date: <br /> Phone: S2 �1��-33� office cell <br /> Mailing Address: I 2Z1'7 �(o (e Cit : �� ,p ZIP: S 33 <br /> Contact Person: i urfo^ Applicant is: on rac or / Homeowner (Cfrcle One) <br /> Email and/or Fax: a 6 �y C� � CP"� <br /> PROPERTY OWNE INFOiRMATION: <br /> Name: �Yan � C�nQ 'P�'ed w�y <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHtTECT/ENGINEER NFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: � City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATI N: <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 �eck ��� <br /> ❑ Relocation detached garage ❑ ffice/ ommercial ❑ Private Sewer <br /> ❑ Other. (specify) � ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may r quire ❑Commercial ❑ Other(specify) <br /> MCWD review 8�permits. I ❑ Industrial � ❑ Private Well <br /> Minnehaha Creek Watershed Distri�t(MCWD) ❑Other: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 ' <br /> Phone: 952-471-0590 � <br /> Fax: 952-471-0682 <br /> wwrw.min neha hacreek.or <br /> Estimated Construction Valuation (excluding land) $ y���'O <br /> Packet Last Updated: 03-06'2012 <br /> -21 - <br />