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. <br /> City of Orono <br /> Building Permit Application ,� �3 g `� 9 ,� <br /> for New Structures or Additions � <br /> Mailing Address: `(P Permit number: O ���—��J� <br /> Q�r PO Box 66 <br /> � `w0 Crystal Bay, MN 55323-0066 �,)�� Date received: �— �/ <br /> StreetAdd�ss:' Q � � � Received by: <br /> y ,� 2750 Kelley Parkway /f� ' dQ� �/�, Plan review fee: �/ — � <br /> �' �` Orono, MN 55356 n '�/"'� S9, <br /> 1qkfSH��� Main: 952-249�600 �/t�� Total Fee: aj.� <br /> 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: ,3 � c�' ��e b N ,SS'3�'I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is requiried with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficienf on-site paiking is avai/able. Non-permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: ��" <br /> Name: �6Y],�,I j y�ka T1�(„�"tj�`p'1�� �N!i � <br /> State License# Expiration Date: <br /> Phone: (cell) �,��� . � g . g/7 g (office) 3 z0 ' 2'.SS• 1(o b�{ <br /> Mailing Address: D �LL �4/e �/� 5 Ci : JLLVyJjZ ZIP: Z <br /> Contact Person: -�-; y�.� pa,rspy�5 Applicant is: ontrac o / Homeowner �c�►�b o�.� <br /> Email and/or Fax: �O�rs orr S@ 7`�.✓G i�YJ [ CaY� <br /> PROPERTY OWNER INFORMATION: 1 � nL <br /> Name: gU � X <br /> Phone(day): � Z <br /> Address: G� OI/i/�" �� City:�p��2g'}a ZIP• 'SS 3�� <br /> Email and/or Fax <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: �"`��'"" �S�} '" ���LQ 3 <br /> Name: 1��I � Ir��o►'1 (���/1G51� �G�ll-r'eG�� <br /> Phone (day): � , <br /> Address: tL W S� Ci : �I.LW1�_ ZIP: �j Q� <br /> Email and/or Fax: � <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation Q�rn�I detached garage �Residence ❑ Private Sewer <br /> �Other: (specify) I� ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> Public 4-feet or greater �Public Water <br /> **Any earth movement may require �Commercial ❑Storage <br /> MCWD review 8 permits. �� Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eCi ❑ Private Well <br /> 15320 Minnetonka Blvd � p �� ❑�he�(SpeCify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � �C7�C�V� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />