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♦ <br /> � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> _ Mailing Address: Permit number. Z(� � ^ -- � <br /> ���Q�� PO Box 66 <br /> / Crystal Bay, MN 55323-0066 Date received: � <br /> � � Street Address:' ����p C d� � <br /> -+ �. � 2750 Kelley Parkway P(an review fee: � �d�� �� <br /> �'� ��� Orono, MN 55356 L1��t'"� <br /> �t <br /> '�kfsH�� Main: 952-249-4600 o a ee: �,� <br /> � 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� j`f �5� (C�� <br /> Incomplete applications will be returned. (Please print) �7 <br /> GENERAL INFORMATION: � (�r�s� �����/ <br /> Job Site Address: p � s /�4 w .�,��1 t� <br /> Will this be a Parade of Homes, Remodelers Showcase Hom or other Di play Home? ❑ Yes No <br /> If yes,a specia/event permit is required with Pofice Department and City Council approval 60 days prior to the event. Shuttle bus service will b <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# �(p ,�( 3g Expiration Date: �3 2! / <br /> Phone: (cell) (0/2 3�3 �c�33 (office) 952 •�f S�o o5(d-��' <br /> Mailing Address: q 1 'd ol, Cit : ""b�'rv�- ZIP: <br /> Contact Person: H r�s �c. � Applicant is: o / Homeowner (Circle One) <br /> Email and/or Fax: h � / . C�r� <br /> PROPERTY OWNER INFORMATION:J���en <br /> Name: sus,+nr �m•�n�44f�i! <br /> Phone(day): (Q�2. �O. 5�9 3 • <br /> Address: S/ljU G`taw�t.» � . S, Ci : � ZIP: lo <br /> Email and/or Fax �;,��h �da,,,�,�,.� p� Go�•,rw��-4.. .r��--'� �snnd {h ��.V1e <br /> u <br /> ARCHITECT/ENGINEER INFORMATION: _ _ , / <br /> Name: v v I7� n rnu/� N/G�--t�-�SoY� <br /> Phone(day): . �J <br /> Address: 3�Fo�— 1L��w.�tr �,a.r�ai /1/aVfh S"T�E�'� City:�� , �'h ZIP:$-S�`l�'�i'�� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: ' v � � � u�� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction �.Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck �.Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage Residence ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo �Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ l�('�� I� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />