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�/ �SC.�'`�:.:�J 1��-'►'�'"r'�� S 14�c-� <br /> 1 <br /> ' ' �j €�� �'�Lv � -f-� !�.-� i v� <br /> City of Orono <br /> `' Building Permit Application � � 8��• 3� <br /> for New Structures or Additions <br /> MailingAddress: Permit number: -'� � ���� � <br /> �Q q,� PO Box 66 <br /> �`V Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' ived by: ' �.� <br /> � ` 2750 Kelley Parkway 2 �L ' �review fee: �j . �� <br /> F � Orono, MN 55356 � w�: <br /> �'�k�s�o�`` Main: 952-249-4600 Total Fee: <br /> 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: 3223 SN�D�(WOO� r�u..E <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 prro�to the event. Shut le 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: C!-FaRc�S Lu�o Go. L.•�-•G . <br /> State License# �C !v3 5 Z�{-5 Expiration Date: '� _ 31 � ZD��} <br /> Phone: (cell) ��7 _ ¢�p • 'j(�-Z (office) �t Z- 3�'`�- 170� <br /> Mailing Address: SO Z � E. Cit : �lou ZIP: $' ¢ <br /> Contact Person: ��E L i G�T Applicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: �t�cly� �S��zt„�,�C�.IDO • GoM <br /> PROPERTY OWNER INFORMATION: <br /> Name: � Ct�-r�.R1.�-'S P�btD C,o���1-,t-`�_ <br /> Phone (day): Cc��2_ �Sq-���� y <br /> Address: _ ��� Z3M0 �� �, � City: Pc.Yr�ou7�/ ZIP: �S�-�3' <br /> Email and/or Fax SLi��� CE.�,�,�-S�p�_C�M <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: Cl���-t.-'S C u,UO C..a • L-L •L� <br /> Phone (day): (o►Z- 3S�!- j709 <br /> Address: /$`vSo Z3fzlo /4�1/t . /�, c�ty: p�yrtovrll ZIP: .s5�¢7 <br /> Email and/or Fax: SL�G�T�.° C1�i421aE5 G�-IDC� . C.vlti( <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> �New Construction �'Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater � Public Water <br /> '`*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑ Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> � <br /> Estimated Construction Valuation (excluding land) � 4( � �Q�`j� —' <br /> Packet Last Updated.� August 2015 <br /> Page 21 <br />