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t i <br /> . � City of Orono � <br /> Buildin Permit A iication a ���?� <br /> 9 pp <br /> for New Structures or Additions <br /> ,,.----,. Mailing Address: Permit number_ c�lJ // — �/S � <br /> i�,0,�. PO Box 66 <br /> �Q s � Crystal Bay, MN 55323-0066 Date received: ����,> —// <br /> �I ��� • � Received by: <br /> `,a, y �� �` �,�, Street Address:' <br /> \�' � �`��� �ti� 2750 Kelle Parkwa <br /> �� ^� x, Y Y Plan review fee: , � <br /> t,y�t ,};-r g� Orono, MN 55356 ! r <br /> �;;ESHO. c�G�l� � J'`�.J <br /> --� � Total Fee: <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � C��'� ��,�.- � r� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other D splay Home? ❑ Yes �No <br /> If yes,a special evenf permit rs required with Police Department and City Councif approval 60 days prror to the event. Shuttle bus service will be <br /> required unless appficant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: /�,`-t-r- s-ru�.Q-�" -� � L° <br /> State License# � Expiration Date: a O 1� /Kk,Z-� <br /> Phone: — �-- ��j5� office) �Ts',,z- �5 � - ' - �6-- �� "-' cell � <br /> Mai(ing Address: �p y�- Clt : y7`F�'t`pw,.� ZIP: 5 5- �Y <br /> Contact Person: ��� �it,�T-r t/f c-a��G� Appficant is: Con / Homeowner (Circle One) <br /> Emailand/orFax: ��,�,_r.�/�.�r-�,��-�,� }�:z �F..�C a�� C�S-S--z 363 <br /> PROPERTY OWNER INFORMATION: n <br /> Name: � �.c Z k � � 1��'��`�- J� �� <br /> Phone (day): '>�� —SS� - 9'�.Z / <br /> Add�ess: ; ��� f�-ee_c� 12 ..� ,,,� �,^� ;� City: ��'���c O ZIP: �� �-�jV/ <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �,�,-t—��10�/ �i�`c� �� -r���r� ✓'�. � 5 -t-���'p <br /> �hone (daY): �/ ,r�— �� �77`L <br /> 'dress: City:SG�.orcu.-�a< ZIP: � s �� <br /> iail and/or Fax: l� !� C.^V��C3�-t- .���//it 5. . C �„� ' <br /> PROJECT INFORMATION: � <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Suppfy <br /> ❑ New Construction �Single Family with Residence <br /> ''�nAddition attached garage �Garage/Accessory Bldg. ❑ Public Sewer <br /> ��Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocafion detached garage ❑ Office/Commercial �] Private Sewer <br /> ❑ Other:(specify) ❑ Muifiple Famiiy/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial �Private Well <br /> Minnehaha Creek Watershed Disfict(MCWD) ❑ Other: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phane: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � <br />