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. �► , <br /> � � "' � ��/• � <br /> °� City of Orono -� <br /> � ` <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �DD 9 —OD�'.3� <br /> g,�� PO Box 66 <br /> 0 t:\ Q Crystal Bay, MN 55323-0066 Date received: ��-19- 0 9 <br /> ���4:�•�;` s,J Street Address:' Received by: c(J G�� <br /> � t;_ �,,.,� <br /> � ��'�M- ti <br /> �, ��p.�,� G� 2750 Kelley Parkway Pian review fee: c��d�}—�O �3 3 <br /> L�xESHo4'� Orono, MN 55356 T� 3 g, d <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: I � �7� 5��_c;_�,� �,�1�e� �'� <br /> Will this be a Parade of Homes, Remodelers Showcase ome or other Display Home? ❑ Yes '� No <br /> If yes, a special event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service wi/l be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMA ION: <br /> Name: __���,^ ���<r�_S ��- Lynn�_ �m-rs <br /> State License# (�d .�- Expiration Date: n dt <br /> Phone: �j,S,�- y i 5-- 7�-I '� (office) (�f 2-- ;�.,'�f� - �4�,�. (cell) <br /> Mailing Address: / 6„ % f-�„ Cit : , 7n � ZIP: - <br /> Contact Person: �,�h �f� Applicant is: Contra �or Homeo � (�irc�e one> <br /> Email and/or Fax: h����,�S v;�������_�E� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �r�c�v`. �F�-�✓� <br /> Phone (day): �,1Z— -�.40 - �`I�.�► <br /> Address: 'r- / Cit : %� ZIP: <br /> Email and/or Fax _�e.���,�; %G �n C`n�. C'_�rr► <br /> ARCHfTECT/ ENGI ER INFORMATION: . <br /> Name: ��1.;n���r..� �.:--.c� ��:�.�i�. <br /> Phone (day): ���3 - 7��; -, y��;�y <br /> Address: � U� �-,._� }�w."�-� 5� # /C S"" Cit : <br /> y - �.r_..;.��' ZIP: <br /> Email and/or Fax: _�r �� �� � ( E�,�,� , L;;;�� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with f�Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. (� Public Sewer <br /> ❑ Accessory Building ,� Single Family with ❑ Deck <br /> ❑ Reloca(io�n �) R � , detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: s eci � E ❑ Multiple Family/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 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 /> Estimated Construction Valuation (excluding land) $ �'�� d��� �� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />