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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> — _ Mailing Address: Permit number: D( ���2� / <br /> .g,�,�.\ PO Box 66 <br /> O � O� Crystal Bay, MN 55323-0066 Date received: �O-Z0-�� <br /> ���� Received by: ��S <br /> `1a t� ,, StreetAddress:' <br /> \'�, . � G�F/ 2750 Kelley Parkway :Plan review fee: o? D<<-'O l 2.,'j q <br /> \�. , �j Orono, MN 55356 � GG• <br /> ���o. 3o3•3�i b6l <br /> _=-- Totaf 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: ��s� " 6 L- <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 evenk Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO <br /> Name: �ir�rwa+��f .a �'S <br /> State License# Expiration Date: 3 3/- ZO/Z <br /> Phone: �0 9�` office �/ - Z o -//y cell <br /> Mailing Address: S �s ��`v�c Cit : rr ZIP: ,$� D <br /> Contact Person: v i i Applicant is: ontractor Homeowner (Circle One) <br /> Email andbr Fax: Sfw„� Q �n r�ws�i �t� /vrrr5 � co n►-� 763-y�>- v3�2.- <br /> PROPERTY OWNER INFORM 4�TION: <br /> Name: ,/tS5 ��� <br /> Phone(day): � �- � <br /> Address: � O�6 ..J�+^G City: ��� ZIP: ,5 5.��� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 eck <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�pertnits. ❑ Industrial �-Private Well <br /> Minnehaha Creek Watershed Distnct(MCWD) ❑Other. (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ �Q pQ� <br /> r <br />