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r <br /> � , �� � �� � <br /> . �.-� ��� �� <br /> city of Orono ���' 3 �� <br /> ' 'n Permit A lication �/� <br /> Bu�ldi g pp <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � / a— �/� $ � <br /> O.��,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: g^���� �.. <br /> � a Street Address:� Received by: <br /> G�' 2750 Kelley Parkway Plan review fee� c�O lo� —��d <br /> ��o�,� Orono, MN 55356 � <br /> Total Fee: ��� $�'f <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �g� �Gr wv� r-a i, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: .. <br /> Name: � �fi c. <br /> State License# L Expiration Date: d 1 <br /> Phone: � b� S office - Q s cell <br /> Mailing Address: .O, o + Cit : �. GrTd�r� ZIP: 5''S �`4' <br /> Contact Person: ,�' Applicant is: ractor / Homeowner (Cirocle One) <br /> Email and/or Fax: �y��•-�y-� s ta,,c . �z <br /> PROPERTY OWNER INFORMATION: <br /> Name: B�b a-'S t 1t��z � <br /> Phone(day): ( - - <br /> Address: �2k�0 �.'}�Gr K�r'r-�o►-�\ Clty:��/-�v�-O ZIP:rj 53�.� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> ��ame: e, �c� . <br /> Ptrme(day): — <br /> Addnss: City:�o'�� �r^� ZIP: <br /> Email end/or Fax: <br /> PROJE�T INEORMATION: <br /> 1.Typs of p:oject 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Constnction � Single Family with ❑ Residence <br /> �Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> Accessory Bulding ❑ Single Family with �Deck <br /> ❑ Relocation detached garage ❑Office/Commercial �Private Sewer <br /> ❑ Other: (spec�fy' �r�-�� �+��� ❑ Multiple Family/Condo ❑Warehouse <br /> , ❑ Public ❑ Storage ❑ Public Water <br /> """Any earth move�neM may require ❑ Commercial �$Other(speciiy <br /> MCWD review 8 peRmits. ❑ Industrial S'C�cc'� �r.�K-� ❑ private Well <br /> Minnehaha Creek Wate�shsd Distrid(MCWD) ❑ Other. (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 � <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n ne h a h acreek.or <br /> $ 02 O�p�0. .� <br /> Estimated Construction Valuation ��xcluding land) � <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />