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� � r� �3� <br /> , , � �o I Z- <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions �`�-�3 <br /> — Mailing Address: Permit number: — �g 7�j <br /> 0 PO Box 66 <br /> � � Crystal Bay, MN 55323-0066 Date received: — — <br /> ��� � � �\ <br /> ,�� �5 �� <br /> �,I� ���,��_ �I I StreetAddress:� Received by: � <br /> �`�',�,��r,,��j�,��� Gti' 2750 Kelley Parkway Plan review fee: .3.5• � <br /> �g �$'<= g,�.-%' Orono, MN 55356 <br /> ��9. �s�o ao�a -�D 8�3 <br /> _= Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 <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 �2 Sha���wr���� ��a C <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 un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I FORMATION: <br /> Name: i?ve �� �- �►'�i�- � l NC <br /> State License# (�C E 3( g 3 q Expiration Date: 3 � / <br /> Phone: office � -- - �� C� cell <br /> Mailing Address: (p ,E�.�;�� �� Cit : jorv� I(�« ZIP: .SS�3 <br /> Contact Person: �,q Crt, �,t�P��1.�•� Applicant is: ontractor- / omeowner (Circle One) <br /> Email and/or Fax: �u� �pvs�b�� I�P�t (`� Rv1.Ct��1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: S;r�� /;.�2� <br /> Phone(day): 2- � _ 2 <br /> Address: 2(7Z S��a� ..,� i,�r>oo �� City: ��,cJC ZIP: 55��( <br /> Email and/or Fax 5�'eve� c� iNG��IC'U.�e:�'►'1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �,�5 <br /> Phone(day): <br /> Address: f 0135 �(7 �' i�e• City: � �yv�a�� ZIP: S54-yZ <br /> Email and/or Fax: Rsm r�ie n ����€�r�CaS,—:her <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 �,Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. `� Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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 B�vd ��-r„ �Y''1�� <br /> Deephaven,MN 55391 T� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Estimated Construction Valuation (excluding land) � �� ,�SG. O O <br />