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� �.Q-� Q o-�fi.� ..��t/l�cc�Q 7-�s�J' <br /> � ` ' �=��-�7�'S-�1.� <br /> City of Orono � ��LP��� <br /> Building Permit Application— � ��-,�� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ���3'"0� � <br /> O.¢,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� —�3 <br /> ,� �, StreetAddress:' Received by: � <br /> '�,�, Gtiti 2750 Kelley Parkway Plan review fee: , � <br /> L�E3H�g'� Orono, MN 55356 ���_�� I <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: ,���� ����pr�l ; Y�� �ri r� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �]-Pd�� <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 wil!be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: - <br /> Name: ��(� ,c\-.-,,c \ `�����,�-� -�-� � �b�,�,��\ c��1.. <br /> State License# Expiration Date: ------- <br /> Phone: � ��- �O--r'1��� �. (office) ��y��r� -- C' �i�l t��ll<<Ir1� (cell) <br /> Mailing Address: O � llav'�.\� � - � v ' C�t : l.�.oci ' ZIP: ��`3 <br /> Contact Person: ob�� lr1 Applicant is: Contractor / omeowne � (Circle One) <br /> Email and/or Fax: i���, „-� �--� � �_ �� ��l i � C�� �'Y� <br /> PROPERTY OWNER INFORMATION: - 1� <br /> Name: _ Y1�:��i C_�r��r� � ��-C-��Z�-� + K��J i � �"'��-��<<-,�— <br /> Phone (day): _�Q 1�-�4C> —c1 ���f � <br /> Address: �C�z"3C7 �',��nn���� v�e.__ �r� v-�. City: �2u�� �� ZIP: �-v��9 I <br /> Email and/or Fax �,�,-, ; s� ���,c, � .�.' (� G C��� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <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 /> ❑ Ngtiv Construction [�-8�1e Family with �'rtesidence <br /> ��ddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ��rivate 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 rivate 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) $ ��� ���3 �J <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />