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. City of Orono 1� ���� �� � ���- <br /> Buildin Permit Application �� � <br /> 9 <br /> for New Structures or Additions <br /> Mailin Address: C � <br /> g,0,�. PO Box 66 Permit number: �( � —� � <br /> � � � <br /> Crystal Bay, MN 55323-0066 Date received: �.'�--� � � <br /> ��'3" Received by: �' <br /> ,� t��,�t;�_,1� �, StreetAddress:' <br /> �',�c, � '`� "�� Gti 2750 Kelley Parkway ���<< C�G��� Plan reviewfee: <br /> L9xESH0¢�' Orono, MN 55356 � � �� <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 applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> � <br /> Job Site Address: �j(% .�� ,-� N r y E- �/1- <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 event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APP,�ICANT INFORMATION: <br /> Name: t'���ic�t'�J Cc� �� t r✓�.�-tY-'1 LL-- L <br /> State License# —� �s�— Expiration Date: '��� 3 r - J <br /> Phone: , Z- :� � "�� office �•-:.�� cell <br /> Mailing Address: ;' (,�,��_5{-: r� :r.-� Cit : ��.•� .)•"' ZIP: r�:i Z� <br /> Contact Person: �'!�; �( ,�-,b.e�/ Applicant is: ontracto � / omeowner (CircleOne) <br /> Email and/or Fax: /�� 1-��,., Cc�. s��r� ✓.-�F%��� C� %hYF«�,�/�, ��,.-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: Tr��'r^,1 r���r�� 5•� f=�` 1 <br /> Phone (daY)� �l�Z^ �f l f�- Z.�� 7� <br /> Address: Zr6CC� So�✓1Fr�� P � L-�� City: C^i/`�°�'tC.' ZIP: �� s'�(.� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFO ATION: �1 <br /> Name: �zj�,,� L �°;-- d lT SSe� r��'� rS <br /> Phone (day): -��Z � 3� ' - C� �+ <br /> Address: ��� �'�lo�r eCti� � S� . _S: ,' l�r� Sl� � CitY: �7�/ S ZIP: �� y C ` <br /> Email and/or Fax: �� �- � ;"y- "�y / <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 �2esidence <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) . ����' �; ��,yl� ❑ Multiple Family/Condo ❑Warehouse <br /> �" -��� z"�� s���y },,�r � ❑ Public ❑ Storage ❑ Public Water <br /> `*Any earth movement�ay requ re ❑ Commercial ❑ Other(specify) <br /> MCWD review&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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ /����;�; ; ` <br /> Last Updated: 4/26/2011 � <br /> :� <br /> �-- 11 I\i�`'i,-� '� 1'a n. �C7�.3 r I �� '� - 19 - <br /> �1 ��`' � � �C 7C,.��� ��.'1,� d���� �� <br /> ._�.�a3�°���'� <br />