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r ' Y � / <br /> 1 , � /`//�� <br /> � � <br /> � City of Orono �v `� , �� <br /> . r3� 7 <br /> Building Permit Appl�cation � <br /> for New Structures or Additions <br /> Mailing Address: Permit number. Z `(X� <br /> ��� PO Box 66 <br /> ; �\ Crystal Bay, MN 55323-0066 Date received: / — z-� <br /> � 1 Street Address:� Received by: - <br /> " ' �y,' 2750 Kefley Parkwa . <br /> "y ' �- (�� �er►review fee: _� .Z/ � 3(� <br /> F Orono, MN 55356 _ '__.__ ._.��� _��.f <br /> � <br /> k'Fswo E Main: 952-249-4600 <br /> Total Fee <br /> `" Fax: 952-249-4616 www ci or;sr�o rnn_us r ' }� � <br /> This application form must be completed in full and all required information mus e submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 72`� �,� f�- �t��-�- <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 required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil!be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: � <br /> Name: ��►3 ��>��--�-R S L.LL . _)� ��--i►�-ia - <br /> State License# L -- Expiration Date: <br /> Phone: cell - -. Z � - S 3 office - Z �` - <br /> Mailing Address: - ,c �,n,� Ci : k-'j �- bk.� j,� IP: <br /> Contact Person: • p,-R,;r�-}- Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: rrrt l�h „ Id��51 I L � a�et, / t c'� <br /> PROPERTY OWNER INFORMATIO,�I <br /> Name: �:i���^��-- N1l.l, �(3i-+` �s.�:�� <br /> Phone (daY)� ��c;L-47i� -4��7�_ <br /> Address: -- r•- p.v� ,� c� : i�w�z�r�- z�P: �3� <br /> �L� % <br /> Email and/or Fax �--� ��-��f�v�c�v�i 11�c' • Co r--� <br /> __- -_ <br /> . V J <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �I-�-c�vv.,i.'��,�.5 ri�i� '1��-�3�J�u'1.c - �(Z��i-�rlcz� �5,� <br /> Phone(day): �-43-� (�Z- '�4-t_l� <br /> Address: L���-�-in.t�-c+ti.3 ��t...v �I I ( Ciry:��r� -� ,y ZIP: 2 1 ZS p <br /> Email and/or Fax: hCi�_ ('i.C�.ht�►m 3r�i�« r c,,,,., <br /> < <br /> � <br /> PROJECT INFORMATION: Descri tion of ro"ect: t.(:a►n�r-�aZ G� - tAyr.�r��L �. L, )v <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> New Construction ❑Sin le Famil with �Nater Supply <br /> g y ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accesso Buildin ❑ Public Sewer <br /> ry g ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence �Private Sewer <br /> ❑Other: (specify) ❑Multiple Famity/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 '�Private Well <br /> Minnehaha Creek Watershed District(MCWD) [�pther: (SpeCify) �Othe�(SpeCify) <br /> 15320 Minnetonka Blvd �'�u�� (+1�'�� <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 7'� .�p() <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />