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. City of Orono <br /> � � Building Permit Application <br /> for New Structures or Additions <br /> � Mailing Address: i <br /> �'����V PO Box 66 � Permit number: ��C:� �� '--(�C�� �`��_ <br /> , 0 �„ ��� Crystal Bay, MN 55323-0066 Date received: i' �f' � (o )Q � <br /> i �y�;�; <br /> �'� I�'`"�s;-,%'-- � �. <br /> �� �- s,: � �., Street Address:' Received by: �� <br /> ��t'�'��fy�„ ��/ 2750 Kelle Parkwa r 5�4 � <br /> �� � o Y Y cL V �lG � Plan review fee: ��2 ' S$ "��:j�i� <br /> �kEsxo4"�/ Orono, MN 55356 � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us i Total Fee: <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: �,�� s � <br /> Will this be a Parade of Homes, Remodelers Sh case Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specral event permit is required with Po/ice Department and City Counci/approval 60 days prior to the event. Shutfle bus service will be <br /> required unless app/icant demonstrates sufficient on-site parking is available. Non-permitted events wil/not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION:�` � � <br /> Name: v - <br /> State License# E piration Date: - <br /> Phone: of ice ' � a�j (cell) <br /> Mailing Address: � w�J 1 Cit_�_____ .-� �; ZIP: ,(f <br /> Contact Person: - -- <br /> Appl�cant i : ontractor� / Homeowner (Circle One) <br /> Email and/or Fax: � <br /> ;. , <br /> PROPERTY OWNER INFORMATION: ,� � � �i <br /> Name: /� ��� '�/-�l�/� .�(,�/,�.� ��l <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> ARCHfTECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure T e <br /> Yp I 4.Sewage Disposal 8� <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑ Addition ��b' �� attached ara e <br /> 9 9 ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin , � ' � i�� � 9 n' 9 ❑ Pub(ic Sewer � <br /> rY 9 ��E ����. �. ❑ Single Family with Deck � <br /> C�LI' 1•� �,���C. ' � <br /> ❑ Relocation ,, �.� c 4�tr detached garage , ffice/Commercial ❑ Private Sewer <br /> ❑ Other. (specify) '�C�� ❑ Multiple Family/Condo ❑ Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '*Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> j MCWD review& permits. ❑ Industrial <br /> IMinnehaha Creek Watershed District(MCWD) ❑ Private Well <br /> 18202 Minnetonka Blvd ❑ Other: (specify) <br /> Deephaven, MN 55391 I <br /> Phone: 952-471-0590 I <br /> Fax: 952-471-0682 <br /> www minnehahacreek.or G� <br /> Estimated Construction Valuation (excluding land) � � 1 <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />