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. . � <br /> City of Orono <br /> Building Permit Application � <br /> for New �tru-ctures or Additions <br /> �O� MailiPO Boxr66• �Q 3��t number: �{�� � �� <br /> � Q Crystal Bay, MN 55323-0066 <t�ate received " , � _ <br /> > � � <br /> :f�eceived by , `r �. � ���, '�'�£ <br /> .� o. Street Address:' �nF r � <br /> �' tii5' 2750 Kelle Parkwa a0f1 U� J�� � � , r : ,, <br /> � � Y Y �lan reviewfee� <br /> �a,kEsxog'w Orono, MN 55356 ��,��� S , � � � rt <br /> �Total 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 appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: g�� ,Sd w��e�"S�e �/\. <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 Counci!approval 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 al/owed. <br /> CONTRACTOR/APP ICANT INFORMATION: �� L�� <br /> Name: � e Ca�i S F►�✓c.. <br /> State License# Expiration Date: '3^ 3 1 - <br /> Phone: �'L- � � "�J office sa.�� cell <br /> Mailing Address: g' es�--'� Cit : �r,, e��- ZIP: SS/Z�' <br /> Contact Person: /�;,�( �b.e c� Applicant is: ontracto �/ omeowner (Circle One) <br /> Email and/or Fax: �p t�e:� Cc� S r v��I-1b�t� ��f���� <br /> -T <br /> PROPERTY OWNER INFORMATION: <br /> Name: � � � <br /> Phone (day): 61 Z^ �I`�f''- � .�� <br /> Address: �gs� �,������ City: �rorl0 ZIP: S,��i� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFO ATION: �1 <br /> Name: �v S C.�e!� 4 .iT S.S�C r�'�2�5 <br /> Phone (day): G n� �S - �'� <br /> Address: �7�" yv��_r iC� S' , s�i`�-e SO� City: �/�.� ZIP: S,S y� <br /> Email and/or Fax: �(2- 3 Sy' 3� % <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑Single Family with ;�tesidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �.Other.(specify) rk �f'� ❑ Multiple Family/Condo ❑Warehouse <br /> -l-+a �t1 ��y�-,vur� ' ❑ Public ❑Storage ❑ Public Water <br /> "'Any earth movement rrl y requ re ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (exduding land) $ ,o(,�� r <br /> Last Updated: 4/26/2011 � <br /> � � ��c,,, � �.,-r.�l- (J v� ('f �� � -�s- <br /> "\ I�..�� fi� 1 ' _ �7C 7 � 1-r7.-1 G���jl ,� <br />