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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> r Mailing Address: Permit number: 0/7--0�3 <br /> 0�T PO Box 66 <br /> 1 VO Crystal Bay, MN 55323-0066 Date received: foZ <br /> / l Street Address:' Received by: <br /> y ,� 1 2750 Kelley Parkway <br /> c? �� <br /> Plan review fee. <br /> HO�� Main: 952-249-4600 <br /> Orono, MN 55356 Total Fee: a �� <br /> 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 /> GENERAL INFORMATION: <br /> Incomplete applications will be returned. (Please print) <br /> � AA ,1 � / <br /> Job Site Address: oo'��c% —A—Low— <br /> o✓(D /44A 53 <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 with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPVCANT INF RMATION: <br /> Name: <br /> State License # Expiration Date: <br /> Phone: cell CfL- – office <br /> Mailing Address: Ue— Cit : naKv <br /> Contact Person: 5q6021gApplicant is: Contractor / Homeowne <br /> (Circle One) <br /> Email and/or Fax: t,c sso_ So►loto✓t L3, ,w A, ( •ev-1,t <br /> PROPERTY OWNER INFORMATION: <br /> Name: E-�jeCkJA <br /> Phone(day): <br /> Address: City: " ZIP: 3<Jb <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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: Description of project: Q Pt <br /> 1.Type of Project 2. Proposed Use 3.Structure Ty4.Sewage Disposal& <br /> ❑ New Construction Sin le Famil with Water Supply <br /> � 9 Y ❑ Accessory Bldg./ <br /> ❑Addition attached garage ❑ Deck <br /> El Public Sewer[:1 Accessory Building El Single Familywith ❑ Ofce/Commercial <br /> ❑ RelocationQQ detached garage E Residence <br /> Other: (specify) �akIA A_f i t`n� El Septic <br /> El Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> *"Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.rninnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />