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. , ' r:: ! ��u II �� �W��� . <br /> � � C�������� p���fl���p�fl������ <br /> ��� ������������� ����������� . <br /> Mailing,Qddress ��t.�:;;:• ;:.=�::•;�,.;.;•;:.•r . <br /> '�-�� PO Box G6 '�Pe:rr�jttnumb'e`r.'`:�`�c>�' �?:.`:•'''''�.g,,�,~ <br /> :���, �::::�::. .. . . , =� <br /> Crystal Bay,MN b5323-0066 �� ;'Date�received;�" ,• •-Z' • <br /> �.w';.::�,:, . <br /> StreetAddress:'. ' D' :�:Re"ceived:by;" ' <br /> .��� :� ::��� . 2750 Kelley Park�ay n� �� �� � <br /> �'��.=:: '�G �/ ::Plan::review•,fee:: • <br /> �1���� ' •�• �; Orono,MN 55356 �' .;":::`��;' • ,. • '.?1'3l�=01 Z3C, <br /> '��ES'�flQ' <:_,<;:.; �; � •. <br /> 'r;Total Fee:. <br /> Main: 952-249-4600 - Fax: 952-249-4696 www.ci.orono.mn.us :,.k,,: ' - '.�';Q.���.CI��.� .� C���•J <br /> This�appli`cation:form�musf.be'co�mplefedi'in;.fu,ll�arid'all�;requi�ed�information;must:b'e:subrriitted: �� <br /> Incomplete�applicationszvvillibe�returnecl: (P/ease prinf) ' � � <br /> G�NIERAL IN��RMATI0�1: <br /> Job Sgfe Addres�: � 3 7. �'���,�A� 'F7rZt.v� <br /> Will fhis be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes ❑1Vo <br /> /fyes,a special evenfpermif is required wifh Po/ice Deparfinent and Cify Counci!approva/60 days prior fo the eVent. Shutt/e bus seivice will be <br /> required un/ess applicant demonstrates sufficient on-sife parking is available. Non permiffed events will notbe al/owed. <br /> COt�T'RACTOR/APPLICAlUT IIVFbRMATIOIV: <br /> Name: �loon7��c.� ga�L��-� . <br /> Stafe License# �GppZ'i2(o F�cpiration Date; _ 3-31- Sg <br /> Phone: {cell) . � (offtce) q$a-345-0543 <br /> Maiting Address: �E L�Rtt,�D E +�t�90 Cifi : Z�p; <br /> � Contact Person: �Y► Applicant is: o tractor Homeowner (Circle One) <br /> Emailand/orFax: nn;uvr��a�rai �.�oe a � ut �c .CnM <br /> � PROPERTY OWIV�R I�dF'ORMATION. � <br /> � Name: 4An-�E <br /> Phone(day): • � . '— <br /> Address: ��t : zIP. <br /> Emai(and/or Fax <br /> ARCHITECT/EtVGlNEER INFORMA710N: <br /> Name: _��n E, <br /> Phone(day): <br /> Addrass: " Cif : ZIP� . <br /> Email andlor Fax: . <br /> PROJEGT 1NF0}aMA710N: Descri tion of ro"ec�: <br /> 9.Type of Projecf ' 2.Proposed Use 3.Sfirucfure Type 4.Sewage Disposaf& <br /> Water Supply <br /> ew Consfrucfion �Sln fe Famif wifh <br /> � 9 Y �Residence <br /> j]Addition afEached garage ❑Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Si.ngfe Family with ❑Deck ' <br /> ❑Reloca#ion defached garage ❑Offce/Commercial <br /> ❑Ofher:�specify) �(Mulfiple Family/Condo ❑Warehouse �Private Sewer . <br /> ❑Public []Storage �'Public Water <br /> ��i1ny e�ri'rl tnoVef�ersgtYiay a;so rayuira ❑Comm�rcia( ❑Ofher(spzcify) <br /> MCWD review&permiis. ❑lndusfrial � <br /> Minnehaha Creek INatershed Disiriof(MCWD) ❑Other:(specify) ❑Private Well <br /> 9 8202 Minnetonka Blvd - <br /> 1�Seephaven,MN 55391 <br /> Phone: 952-�F79-0590 • � <br /> Fax. 952-471-0682 <br /> www.minnehahacreek.or � <br /> Estimated Construction Valuation (excluding land) � � �.�Q D(�(� - <br /> 1 <br />