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� � � `' <br /> ` �' � � u,,2 �Z-�- ( 3 <br /> City of Orono C,l�r � _._ �- <br /> .�`� �� <br /> Building Permit Application � 3 g , -� � <br /> � � <br /> for New Structures or Additions _---_-� <br /> Mailing Address: <br /> ^,. PO Box 66 Permit number: ��— � I I 7 <br /> �O`v� Crystal Bay, MN 55323-0066 Date received: ( " — �3 <br /> Street Address:' Received by: ,s <br /> yF ,� 2750 Kelley Parkway Plan review fee: �p2. �� <br /> c? Orono, MN 55356 <br /> `q'rFSHO�� Main: 952-259-4600 Total Fee: °���'3'0��7J� <br /> Fax: 952-249-4616 www.ci.orono.rnn.us �jl;� ,ti:� � �� ut� <br /> This application form must be completed in full and all required information must be mitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: '.�t�'S� (�G�'�L'�� �c�a� �• : f���-'�� � ,M.r� S3 3S� <br /> Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes �No <br /> If yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �35 �EP�ik-- r��'.� ��McyF�u�,lF� ��t.�C.a <br /> State License# �jC �;�$y-s Expiration Date: 3 � "� <br /> Phone: (cell) C'.�5-� �7c; S 3 z.rJ (office) ,�✓jr1 <br /> Mailing Address: L3L7 c��'a�ETT� ,� City: �,/,gy�z,�r,4 ZIP: ��-3��/ <br /> Contact Person: MrK� STocX�.�6E� Applicant is: Contractor�/ Homeowner (Circle One) <br /> Email and/or�Fa�x: �� ��P�e. A�D 2E,^^�.�E�,r,�6i�L � C��� , c_o�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: E:�;�ti �. .4+� ' ,�l�N' " �w� <br /> Phone (day): " - �,,r y <br /> Address: _3ig� �•7�r ,ea �, � Cit : � ��;�t.�Q ZIP: SS� <br /> Email and/or Fax {�g,Q�!-n,��.}q r� /rJ �;r�t« 1 c�y� j �CL•Yl` � <br /> ' /' ��. . c�m <br /> ARCHITECT/ENGINEER INFORM"� <br /> ��, <br /> Name: nA-� r � �. <br /> Phone (day): . ' � t � � <br /> Address: , VW � �` Cit : — i ' ZIP: � <br /> � � �� � Y L�� �,��� .�s..��� <br /> Email andbr Fax: � jJ�� �j�� <br /> \ . �� <br /> PROJECT INFORMA'� �I�;.���"� '�.ti;�` i� �I�S j��N��� r"�r�i�2i3r��Trf� �`',5,,k� <br /> 1. Type of Project ture Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction nce <br /> �ddition /Accessory Bldg. �Public Sewer <br /> 'U Accessory Building <br /> ❑ Relocation mmercial ❑ Private Sewer <br /> ❑ Other: (specify) � <br /> ❑ Public Water <br /> ""Any earth movement may requi, .,;� (specify) <br /> MCWD review& permits. �private Well <br /> Minnehaha Creek Watershed District(MC <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 �� <br /> r <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />