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. . , F L J�.. � _2�� <br /> , � �._ � <br /> ' Cit of Orono ��� <br /> Y ���� � <br /> Building Permit Application ���' <br /> � <br /> for New Structures or Additions <br /> Mailing Address: Permit number. (" � -C/�"[.`� <br /> g,0,�. PO Box 66 <br /> O ` O Crystal Bay, MN 55323-0066 Date received: / (',�� � <br /> � � --------- _.�1z � <br /> ,� -��' �, I Sfreet Address:� �f �`'� "� ,- _ <br /> �'�s,� '�� ���' 2750 Kelley Parkwa ` ���y;r� ��l� �� ���Plan review fee: ���f�� . �?� ���'" <br /> > � � Orono, MN 55356 � �"� — <br /> �'kESHO�`' -- __. _._._... _.____�.___T._.._ <br /> __ __ . <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 /> Job Site Address: ;�,�" �•./,. ST�/i3h S �=��jY �Z/J _ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> /f yes,a specral event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus servrce will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: OL:�� 5 � v�� ' /��'M� �='w N�:-iz <br /> State License# Expira ion Date: <br /> Phone: r.����� ,��, Z ,c�;�,� -�7��, � (office) (cell) <br /> Mailing Address: -f f ? Cit :,�,q ;��,�= � ZIP: 3,-"�� <br /> Contact Person: �7LNN/S /V�lJNIf� Applicant is: Contractor / omeowne (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: U�=.l�l/u )_S 1-C�'l�J�� <br /> Phone(daY)� >.5 Z°���i3 � 7.S`.3 � <br /> Address: �.S N- 5Ti/�3� t3�y �21��. CitY: ��],a,,vLG/'L�ti�IP: _S 73`�-� <br /> Email and/or Fax p,�/L�::yi�.SiyCe�,�/ E� Gl••l,c-/L .• C��i�1 <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: /'LillA/iS i�Zli�-1 f> <br /> Phone (daY)� 9S 2� -¢7,� �- 7 5.3� <br /> Address: Z.5 hr _ S�v/.3.fjs� �3.4 y!1U_ CitY�MAl�cr j-'�,q-,�v ZIP: �S�jS-J <br /> Email and/or Fax: ����.L l"i T SiV�'v,/ �' U�/�iL -. c�-i�l <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 ❑ Residence L�.�"f�'x` <br /> f�.Addition �attached garage �_ � Garage/Accessory Bldg. ❑ Public Sewer <br /> I� Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ OfFice/Commercial � Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial J� 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 _ LL .-- <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 1/26/2011 � �� <br /> - 19 - ��i�j� <br /> �c«T' <br />