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, . <br /> C�ty o� �3�°dnQ <br /> Buiidin� �errnE� i4����catior� � , �� <br /> for �e�nr S�r�ct�res ar �4dditio�s �`��. <br /> Mailing Address: <br /> Q,�T PO Box 66 �ECEIVED Permit number: p�Q1 7�1Dci3g <br /> � �vQ ������ Crystal Bay, MN 55323-0066 Date received: 8-g l 7 <br /> D StreetAddress:' AUG 0 9 2�17 Received by: „Sy� <br /> y , ,� 2750 Kelley Parkwa �v�L����.� <br /> `� L1 Orono, MN 5535��OF ORONO Plan review fee: <br /> l�kESHo��' Main: 952-249-4600 ---'��--=— - <br /> Total Fee: Q <br /> Fax: 952-249-461fi vw��.ci.orono.mn.us i <br /> This application form must be completed in fuli and ali required information must be submitted. <br /> Incomplete applications wiil be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �ys�- ��,;�-�,� � .��` ��,�� <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 wkh Police Department and City Council approval 60 days prior to the evenf. Shuttle bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenfs will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �C:�' i„� I E r-. <br /> State License# , Expiration Date: . <br /> Phone: cell �1c3 �5� 3t (office) <br /> Mailing Address: �� �X-rh ,�� ,,,� �` Cit : ;�,^G ZIP:�5�s <br /> Contact Person: <� � �- „ �-2 Z�j Applicant is: Contractor / meowner (Circle One) <br /> Email and/or Fax: S �7/ <br /> PROPERTY OWNER INFORMATION: <br /> Name: ;fi��{� 1��r 1 a� <br /> Phane(daY)� 7�� 3S 5 y��f <br /> Address: �.�{S� � r,ct� --��cn�a.� �o� -r � City �;r ,,�� ZIP s 5�,�� <br /> Email and/or Fax . <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: C��,. Z�P. <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8 <br /> ❑ New Construction [�Single Family with ❑ Accessory Bldg./Garage Water Supply <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer <br /> � Relocation detached garage ❑ Residence <br /> [�"5eptic <br /> ❑Other.(specify) ��`�T�����.�.� ❑ Multiple Family 1 Condo ❑ Re#aining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> "`Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) � Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 Cl IT�'�Tc-'-� [�rivate Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 ' <br /> www.minnehahacxeekofo <br /> Estimated Construction Valuation {excluding land) $ ������,�, <br /> Packet Last Updated: January 2016 <br /> PanP 91 <br />