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. - .: � -�� <br /> � <br /> � �� �� <br /> City of Orono . � � • � <br /> � <br /> Building Permit Application � � <br /> �� � ,9�, <br /> for New Structures or Additions � � <br /> Mailing Address: �` �/ <br /> ,�T PO Box 66 Permit number: <br /> ��`vQ Crystal Bay, MN 55323-0066 Date received: �D��� � <br /> Street Address:� Received by: /y/ <br /> y � 2750 Kelley Parkway Plan review fee: � �/ <br /> F � Orono, MN 55356 <br /> t�kESHO�� Main: 952-259-4600 Total Fee: ���' � <br /> Fax: 952-249-4616 www.ci.orono.mn.us C�YDIf✓ I •b• <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: ���� ���,,��=�;y�� ��^;v�� __ <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 approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA T INFO MATI N: <br /> Name: � . '` r�> * ��� � �c�'1 "a� � <br /> State License# � � � �' �/. Expiration Date: 3 3/��lSi(�"� <br /> Phone: cell 1Z•- �1 -�� office 2•-�-/)�-�=7l'� <br /> Mailing Address: ,3 '` , � J Cit : � ,�c ZIP: �',S� � '�`' <br /> Contact Person: ,r� Applicant is: orrtr�tbr� / Homeowner (Circle One) <br /> Email and/or Fax: 'k���,t�.r�c,,,E=r—�y����'1 c•�-. <br /> PROPERTY OWNER INFORM TION: � 1 <br /> Name: �'� �� � - 4xJ;d <br /> Phone (day): ` �,i Z' - - �� �� <br /> Address: Z � ,` Cit :�%('G ZIP: .�,�� �' <br /> Email and/or Fax �i � - ..z <br /> ARCHITECT/ ENGI�R INFORM�TION; <br /> Name: � �.r'� ��•��°}"���" <br /> Phone (day): (d j�---�d -.3 L�3 <br /> Address: Cit : ZIP: <br /> Email and/or Fax: ���, �,,,�c�;�;�-���'i-.�.�,►�,;t���3 . C.L%'�'h <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 /> ❑ Ne Construction � Single Family with [3"Residence �� <br /> ddition e�teehe�d"gara'g� ❑ 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 8�permits. ❑ Industrial ��ivate 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) $ �; ��, <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />