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` ���(� �� ��v��� <br /> ��S��I�!!� ���MO`�'/����„���N��f� � <br /> � ��� � <br /> ��R YVEW �`TRUC`�iJR�S �R,/�D�I`��ON� <br /> �,{,� � Mailing Address: ''Permifnumb'e�::;'':;:`'�<�>�: <br /> PO Box 66 �::..:..: ..:... . . ��-����::��.; . <br /> �� �V�:.:. :...: . .. .,....... <br /> �` Crystal Bay,MN 55323-0066 'Date recei'v.ed;. ,�� •�',� . <br /> � StreetAddress:' � <��Received;by` ' � Q� `Y <br /> �= : �, -� .:��-� � 2750 Kelley Parkway ;:Plan"re'view;fee: � J��� , / <br /> � `h � � Orono,MN 55356 <br /> G ;::•.:...•_; . . <br /> �.9 _ .'4,ti` ?::::,. ,. _ <br /> �cESA� " - � O�d� �—�G,T <br /> � `::Total Fee:. . � � , <br /> Main: 952-249-4600 � Fax: 952-249-4696 www.ci.orono.mn.us � . ' <br /> •: ::::::.:::... .....:�. :. , ... . . <br /> This�application;form"musf.be:'completed;in;fu,ll;aritl=all;requi�e'd,.information;must�:b�e:�subrriitted: <br /> Incomplete�applicafions:uvill�be returned: (Please print) ' <br /> GEIVERAL IlVFORMATIOIV: <br /> Job Site Address: .72 �j S-R�a�gqY �,y�� <br /> Will fhis be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required wifh Police Department and City Council approva160 days priorfo fhe event. Shuttle bus seivice wil!be <br /> required un/ess applicant demonstrafes sufficienf on-site parking is avai(abie. Non-permifted evenfs will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: I,Jooa7DA� gv��D�P-S � <br /> State License# �L00292(o Expiration Date: 3-3�- Ig <br /> Phone: (ceil) (office) q52-345-0543 <br /> MailingAddress: )7 C3LUE GiRCt,E D vE rt� Ia� Cit : ZIP: 3 <br /> Contact Person: n�i-r Applicant is: o tractor Homeowner (Circle One) <br /> Email and/or Fax: _,y�������,,�ae c� ��O u i�a.�s .Co rr <br /> PROPERTY OWNER 1N�ORMATION: <br /> Name: �qME <br /> Phone (day): • <br /> Address: City: ZIP: <br /> Email andlor Fax <br /> ARCHITECT/ENGINEER INFORMATION: � <br /> Name: _�M� . � <br /> Phone(day): <br /> Address: � City: Z1P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro"ect: <br /> 1.Type of Project � 2.Proposed Use 3.5tructure Type 4.Sewage Disposal& <br /> Water Supply <br /> �.�Jew Construction ❑Single Family with �Residence <br /> �]Addition aftached garage ❑Garage/Accessory Bidg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> ❑Reloca#ion defached garage ❑Office/Commerciaf ❑Private Sewer <br /> ❑Other:(specify) �Multiple Family/Condo ❑Warehouse . <br /> ❑Public ❑5torage �'Public Water <br /> —•-Any ea►in moversleng may a�s�eay-uirc ❑Comr�ercial ❑Jfher(spzcify) <br /> MCWD review&permits. ❑Indusfrial : ❑Private Well <br /> Minnehaha Creek Watershed Districf(MCIND) ❑Other;(specify) <br /> 18202 Minnetonka Blvd <br /> �eephaven,MN 55391 <br /> Phone: 952-471-059D <br /> Fax: 952-471-0682 <br /> www.minnehaha creek.or <br /> Estimated Construction Valuation (excluding land) � 3��� D(�(� � <br />