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,R <br /> c��' � Cit of Orono <br /> � 1�. Y <br /> �`�1 Building Permit Application <br /> for New Structures or Additions � �a" �� <br /> . <br /> � <br /> /�;O�'� MailiPO Bo r66 . Permit number. '��/� � c�U.�4'3 � <br /> � � <br /> �QY � v� Crystal Bay, MN 55323-0066 Date received: � a /,�- � <br /> �� ��'� � Received by: � � <br /> �y\� �y��� �;� ��, Street Address:� <br /> � � ti � 2750 Kelley Parkway Plan review fee: ��: �:� - f��'� ��-• <br /> \�t���g,'�j Orono, MN 55356 <br /> �,,Esz�a f�3. �� <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� jft�fr,1�� ;L�a��, ,;'�-,l. ������ �,�✓ `'-S �� �' � <br /> Will this be a Parade of Homes, Remodelers Showcase ome 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 evenf. Shuttle bus service will be <br /> required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events will not be alfowed � <br /> CONTRACTOR/APP�-�IC�T INFORMATION/: / <br /> Name: C��-1 C°S �+�ryG�lJ ( .r,rn"f✓ciCtay� ��. <br /> State License# �-���? � Expir tion Date: .�-^�/y <br /> Phone: -���:-?�o_ p��r � office � l,�/,. G;�- 7/�, '' (cell) <br /> Mailing Address ��"r�U 1/rC%�S�:r,�.r�, j,/. /' -�;;/ �^�- Cit�r: r� �-�'��- ZIP: '� �� <br /> �, � � �:_:' � �,, ; .� <br /> Contact Person: �,,�i 5 �Cy,,��,�s�..�{�.� Applicant is: f Contracto� ;/ Homeowner �c���ie One) �? <br /> Emailand/orFax: �'� ��7�r�-=', " ��,:^��;o-,��i�r<<.�o%r /,� %c��-y-����_,7z�i,, <br /> PROPERTY OWNER INFORMATION: <br /> Name: _ �✓��;r' /�c�/6�f <br /> Phone (day): (a/Z _a�� i�/U � <br /> Address: , �� <br /> �' S `;�tc��b� ,�"a�� ��/ City: C�r r'-, v zIP: ' S3S`i <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ` Water Supply <br /> ❑ I�Few 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 <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""`Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial <br /> ❑ 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) $ ' v. �� ��y <br /> . . . .. .. � 4� y . . - , . <br />� . � ' . . � '. ..�.. <br />