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�.,s ' �`• , ' � 'I/ <br /> , � u,l <br /> . � . ,� <br /> ` City of Orono �� <br /> Building Permit Application /� �� <br /> I � <br /> for New Structures or Additions <br /> — Mailing Address: � �: T <br /> , .¢,�,���� PO Box 66 Permit number: - L%% –�/�%J <br /> � , O�� Crystal Bay, MN 55323-0066 Date received: /� –/ 8� 02-� <br /> �; z �` <br /> �,��,,� � �'��� :,. ,,.�',� SfreetAddress:� Received by: <br /> ���'�,�, '���,��'d_ ��`��% 2750 Kelley Parkway Plan review fee: D�� � / <br /> �jt�AEs����%" Orono, MN 55356 ����, � ���� <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: ��`J� .��.ss�-K ����1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a special event permit is required wdh Police Department and City Council approval 60 days prior to the event. Shuttle bus service 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: 1,�% z�'o t-lE.�•� s <br /> State License# Expiration Date: <br /> Phone: fo t z - 3 q(o -(,"1 L g (office) c� �Z - 3 y�., c��z-y (cell) <br /> Mailing Address: S(c Z 3 rl crw.u,.�.�, LRw.c Cit : ,�n��n�- ,w .` ZIP: s s 3 � <br /> Contact Person: g;11 t��,�,��„� Applicant is: ntracf r / Homeowner (CircleOne) <br /> Email and/or Fax: �,;�t (� �:�o l��f-^e s � c�.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��� s�...,: < -Z � s�t ; ,.� <br /> Phone (day): t� � Z - g o�- 3 9 S� �Q Q�l� �r� <br /> Address: 2 `190 S�c gs�-r� ��--� City: I.,.���� <br /> Email and/or Fax ����� ��.� _ <br /> ARCHITECT/ENGINEER INFORMATION: � � .��j�,/� <br /> Name: �2; :1� �v�r f i e r � � _ <br /> Phone (day): � �z - S i c� - 9�a 2 1� ���" ��-��,-�j/„� <br /> Address: y 5 ov ttuJ�l a�a ��c 3� � City: N� K� - �E.��v — <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 /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage (� Garage/Accessory Bldg. ❑ Public Sewer <br /> �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 � Private Well <br /> Minnehaha Creek Watershed District(MCWD) � Other: (SpeCify) <br /> 18202 Minnetonka Blvd �Q��„�A <br /> Deephaven, MN 55391 <br /> �,,,,,y�„� ��;,� <br /> Phone: 952-471-0590 F`'� <br /> Fax: 952-471-0682 -� P u"`� �^"5U`� <br /> wewv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � SD ' �� <br />