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r � <br /> i ! <br /> � � " City of Orono � <br /> �� <br /> Building Permit Application �,1 �� <br /> for New Structures or Additions � gi 9 <br /> Mailing Address: �Y <br /> //�g,��,�. PO Box 66 Permit number. a—�� � <br /> �/� „ � Crystal Bay, MN 55323-0066 Date received: o - � o� -� <br /> I�j ���,,� 4 <br /> I � Received by: <br /> `a ? - ,,�, Street Address: <br /> \'�, � �� ��� 2750 Kelley Parkway Plan review fee: 5�• �T <br /> ��.���Hog,� Orono, MN 55356 a� ! �_B� a� <br /> ��--___-' <br /> Total Fee: <br /> Main: 952-249�600 Fax: 952-249-4616 �:�� <br /> This apptication 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: � 9 �D S'�jev�l►v1� L��. ,YM:r.��.-}�h.�a.i,�e..�.��. MIV <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 Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# �p�g c!1 S� Expiration Date: <br /> Phone: (_g t17 ��g- �q�ft (office) ( (,I�� q g 7• YB 9 3 (cell) <br /> Mailing Address: ; Cit: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email andlor Fax: �;���s n.,u c-I[l�I`� Ln m <br /> PROPERTY OWNER INFORMATION: <br /> Name: • i <br /> Phone (day): rk <br /> Address: �ij.l.t � T��r�..c.ey�c�.,�1 1�. c�ty:Y�r�l� �ro�e ZIP: S-T�31/ <br /> Email and/or Fax �hre.� � �1-,0�-,�-,�.� . �e w� <br /> ARCHITECT/ENGINEER INFORMATION: / �� <br /> Name: Tl,L.c� � ..�Cl�.r' -f �l,�i,r �-s �'�li1l,��� <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 8�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) $ � ZSD �a . a"' <br />